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MINDS IN DISTRESS 


A PSYCHOLOGICAL STUDY OF THE 
MASCULINE AND FEMININE MIND 
IN HEALTH AND IN DISORDER 


BY | 
A. E. BRIDGER “ 
B.A, B.Sc., M.D., F.R.S. (EpIn.) 


Fellow of the Royal College of Physicians of Edinburgh ; Fellow of the 
Royal Society of Medicine of London 


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PREFACE 


HERE are two points from which 
humanity may be viewed, the bodily 
and the mental. 

Hitherto, and for various reasons, medicine 
has concerned itself almost solely with the 
physical side of man. 

The result has been disappointing, for, 
necessary as it is to be acquainted with the 
bodily structure in health and in disease, 
the changes that occur in the latter only 
represent the physical results of a process, 
and not the means by which the damage is 
done.. 

Now the duty of the physician is like that 
of the pilot; to bring his patient safely into 
port, availing himself of every agency with 
that one object in view. 

Therefore, Mind, in the fullest and widest 
sense, must be one of his chief studies. 


vii 


Vill MINDS IN DISTRESS 


But the subject, when we try to confine 
it within rules, presents great and special 
difficulties, and only principles that are of 
universal acceptance, free of speculative 
theory and reducible to the simplest terms, 
are likely to be of any practical utility. 

Of these, I formulate two: 1st, That 
mental comfort depends on a state of balance 
between two main factors in the human 
mind. 2nd, That all minds are divisible 
into two great types according as the reason- 
ing or the instinctive faculties predominate. 
I call them, respectively, the masculine 
and feminine types.of mind. I avoid the 
words male and female, since the line of 
division is not one solely dependent on 
Sex. 

In the following pages I shall define the 
above propositions, and show that upon 
them depend the functional nervous dis- 
orders that afflict humanity, the obscu- 
rity of whose origin is attested by the 
great variety of names, ¢.g., Neurasthenia, 
Psychasthenia, Hysteria, Hypochondriasis, 


PREFACE 1x 


Neuroses, etc., etc., under which the text- 
books treat of them. 

As my appeal is one to the common ex- 
perience of humanity I shall make use of 
the simplest language at my command, and 
as my thesis is—as far as I know—an entirely 
novel one, I shall not refer to well-known 
writers on the subject as they all approach 
it from an entirely different point of view. 


FoLgy LODGE, 
5 LANGHAM STREET, 
PORTLAND PLACE, 
Lonpon, W. 








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Und dazu ward ihm der Verstand, 
Das er im innern Herzen spiiret 
Was er erschafit mit seiner Hand.” 


SCHILLER 





MINDS IN DISTRESS 


CHAPTER I 
THE NORMAL MIND AND MENTAL BALANCE 


E must first get a clear and concise 
general idea of Mind. 

Many of my readers probably have read 
the shorter treatises on Psychology by 
William James, Titchener, Wundt and 
others. If so, they will have been struck, 
as I have, by the fact that, when dealing 
with detached and strictly physiological 
_ problems, such as can easily be verified by 
experiment, the writers are much at home, 
but that when these have been exhausted, 
and the stage of generalization has been 
reached, when the reader is on the tiptoe of 
expectation, eager for a new and cogent 
definition of Mind as a going process, the 
author becomes vague and drifts away 
into a discussion on Monism, Atomism, Oc- 
casionalism, Spiritualism, etc.; in short, he 

I I 


2 MINDS IN DISTRESS 


trembles, so to speak, on the confines of 
Metaphysics, and there he perforce leaves us. 

And the reason for this is simple. Body 
and mind are one and indivisible, but two 
views of the same entity. 

Keep as conscientiously as you may 
to the physiological, the biochemical and 
the mechanical, reject every proposition 
that is not valid in science, yet you come 
inevitably to a wall, more solid and repellent 
the stricter you have been with yourself, 
which bars all further progress, and have to 
acknowledge with Karl Pearson in his 
admirable Grammar of Science that the 
search for ultimate truth on scientific lines 
leads but eventually to self-contradiction. 
You start with X as representing the un- 
known, the vital or the psyche; you work on 
and seem to get fair representation values 
in physiology for certain components of X, 
but you never reach a solution, change 
your method as you may. Only on the 
material side are you happy, for with so 
many data in hand, and such an army of 
skilled collaborating investigators, you in- 
stinctively feel that, in a sensible future, 
nearly every tissue and function will be 


THE NORMAL MIND 3 


ranged and measured, and the body of man, 
as stationary and inert, fixed in time and 
space, will come to be represented by a 
chemico-mechanical formula of great com- 
plexity but of definite accuracy, and that, 
as a final triumph, you may even reasonably 
expect a day when there will be made a 
synthetic protoplasm that shall live. 

But that will not have solved the problem. 
You will only have supplied a further 
instance of what we all know, that when . 
Mind demands anything imperatively, out 
somewhere from the environment comes 
tissue to clothe the idea, to give it what we 
call a material basis, to do, in short, what 
evolution—whether consciously or not, who 
shall decide?—has been doing down all the 
ages and what she is doing daily in the field 
of physiology, not only by adding and de- 
veloping new function and tailoring it, but 
by causing to degenerate and disappear 
that for which she has no present use. You ~ 
will have given further proof that Mind, 
whether represented in the person of modern 
‘man armed with weapons of precision, or as 
a vague creative force omnipresent in all 
that we call nature, is the great generator, 


4 MINDS IN DISTRESS 


the real causa causans, and that matter is 
ever an obedient servant that faithfully 
carries out her commands. 

You will have made life and mind. No; 
you will have made both possible.. A great 
achievement indeed in the popular view 
though the idea that a great barrier divides 
the living from the non-living is a purely 
arbitrary one. None of the roads leads to 
a real conception of mind in its essence. 
We measure the force and rate of certain 
minor functions of the brain, those of the 
special senses in particular which lend them- 
selves to the process readily, and we work 
unremittingly onwards to a more intimate 
knowledge of the cell structure through 
which mind acts, but only to find the mystery 
deepening and to realize the enormous gap 
that exists in this matter between know- 
ledge and understanding. 

To obtain any useful basis from which to 
classify and study mind we have to depend 
on certain anatomical and physiological 
facts just as far as they carry us and then to 
study these in the light of wide experience. 
Only thus shall we find practical guides in 
our work and obtain any useful general rule 


THE NORMAL MIND 5 


that will command the acceptance of all 
thoughtful men. 9 

The Human Mind.—This is best classified 
according to its duties into three great 
parts: the conscious, the subconscious and 
the reflex, automatic or organic. Acting 
all together as in normal persons they con- 
stitute the Ego. But they must not be 
thought of as separate except as a matter 
of convenience in speaking. True, in the 
average life of man each keeps its place in 
function, and we thus come to view them as 
distinct; but there are no fixed and real 
boundaries, and directly circumstances be- 
come unusual the order of this relationship 
is overthrown and they invade each other’s 
department and provide us with many 
extraordinary phenomena. f Some minds, 
being more active than others, or propor- 
tioned differently, show this intermingling 
of function early and under slight stress, and 
in them—as we shall see—it may reach 
easily a great development, and indeed with 
a little trouble, and by arranging our en- 
_ vironment, we can induce artificially, and 
even in persons who are in the enjoyment 
of normal health, many of these abnormal 


6 MINDS IN DISTRESS 


phenomena as we see in hypnotism and 
spiritualism. 

This contiguity—this close relationship— 
throughout the body of the three great de- 
partments of mind is a matter of importance 
and must be kept in view, and though we 
speak anatomically of ‘“‘ mapped-out areas 
of the brain,’ and of the “ great special 
centres’ therein, we do this largely as a 
matter of convenience, for it is not even 
certain that within the brain reside all the 
functions of thought; and Dr Charlton 
Bastian, amongst other authorities, holds 
that the great ganglia of the sympathetic 
system, which are chiefly in the abdomen, 
“have a large share in the conscious life 
of the individual and lead more or less 
directly to a series of voluntary actions,” 
whilst the most extensive and destructive 
disease in the brain, as subsequently viewed 
in post-mortems, has been present with 
a practically unimpaired intellect of the 
sufferer. It is therefore safer to keep in 
mind the three great mental departments 
without tying these down at all strictly 
to special areas in the brain. 

At present the conscious department 


THE NORMAL MIND 7 


alone concerns us and we shall deal with it 
on the broadest principles of experience. 

Mental Balance.—One arm of this balance 
is what we may call Common Sense. This 
consists of our general store of knowledge, 
a register of our conclusions to date, and 
though it is being perpetually modified in 
composition by such new ideas as we accept 
and absorb, yet is the more stable arm of the 
balance. It is constantly being kept in a 
state of general average with other minds 
by means of contact with the current opinion 
of the day, a point that is of great practical 
importance in life, for when an individual, 
or even a whole group of persons, as in a 
profession, isolates himself and fails to keep 
in touch with the world in general, he is in 
great danger of mental distress, for his 
standard is lost and with it his sense of pro- 
portion. This is one of the great causes of 
many mental and nervous disorders. 

The other arm of the balance, for so we must 
call it, is made up of the mew impressions 
which in countless variety and from all 
_ sources, from our internal organs and from 
the outside world, reach and are presented 
to the common sense as to a standard. If 


8 MINDS IN DISTRESS 


the latter be kept active and well stored by 
incessant readjustment with the world-mind, 
and if the nerve tissue on which mind rests 
as its material basis be healthy and adapt- 
able, very rarely indeed will any fresh im- 
pression remain unbalanced, but unnoticed, 
and I may say almost automatically, find 
a place in and become a part of the common 
sense, while even if the new circumstance 
with its impressions cannot be thus at once 
and directly assimilated it will create no 
disorder, for the mind will ‘‘ throw out a 
balance,’ as it is called in philosophic 
language, will adopt a theory that will for 
the time being bring the two arms of the 
balance into equilibrium. This state is 
called ‘‘ making up one’s mind.” 

Now all this may appear too common- 
place to require formal statement, yet on 
this balancing of the two factors—the nor- 
mal impression with the common sense— 
mental comfort depends, and from a want 
of it far-reaching mental distress arises. 

Note how much depends on the soundness 
and stability of the common sense. If all 
minds were compounded in exactly similar 
proportions of the three constituent parts— 


THE NORMAL MIND 9 


the conscious, subconscious and automatic— 
if all nerve tissue were always in a state of 
similar activity, and if the environment of 
everyone were equally restricted and exactly 
alike, then, at least at equal ages, people 
would all possess an equal common sense, 
and any serious difficulty from the failure 
to reach a balance could rarely arise; but 
there is a wide variation in all the above 
factors, and consequently an enormous differ- 
ence in the response to unusual or novel 
sensations; and the result of this failure 
to reach an equilibrium is to give rise to 
phenomena of disorder altogether incom- 
prehensible to persons of different mental 
capacity and to the world at large, and 
leads to grave misunderstanding, the failure 
to balance being wrongly ascribed to some 
vague agent of disease attacking the body 
from without, when all the time it is due 
simply to the fact that the mind (the com- 
mon sense) of the patient is of different 
composition to that of the observer and is 
merely responding in a way normal to 
itself. 

For that reason it is essential to closely 
study the mental composition of the sufferer 


10 MINDS IN DISTRESS 


from mental distress so as to be able to 
interpret the symptoms observed, which will 
usually be found to be only natural under the | 
circumstances and not due to some sup- 
posed malignant external agency. Then by 
effecting a change in the environment, by 
adapting the latter as closely as possible 
to the individual needs and requirements, 
health may often be easily restored, and 
measures having been taken to effect a 
constant healthy contact of the sufferer 
with the general world-mind, a stable 
and lasting condition of mental com- 
fort under all ordinary circumstances of 
life may be secured. Therefore the 
very simple, elementary balance of which 
I have spoken must ever be kept in 
mind. 

Now, in the event of novel experience, the 
throwing out of a balance by the mind to 
effect an equilibrium in the person of good 
sound common sense, who lives in free con- 
tact with the world-mind, is a simple process 
leading to no distress. The provisional 
theory adopted is either affirmed by ex- 
perience, or if not, the theory is rejected 
and another conformable to general ideas 


BWei OM Ce! 


THE NORMAL MIND 11 


is adopted. But when the common sense 
is not of an average and sound order, by 
reason of the isolation in life of its possessor, 
or because his mental composition is not 
in the usually relative proportions, or 
when the mind is of extreme sensitiveness 
by inheritance, impressions quite ordinary 
of their kind and easily balanced in the 
former may lead in the latter to the adop- 
tion of a theory that, while it appears quite 
right to the individual, is widely at variance 
with the ordinary world-mind of the day, 
and for that reason—even independently 
of isolation—be extremely difficult to cor- 
rect. Of this nature are the so-called 
“Obsessions” and ‘“ Phobias” of the 
Neurasthenic, the grievances to which some 
persons seem so pertinaciously to cling and 
the distorted views of the Hysterical. These 
appear weird and unreal to the man of the 
world, or even as evidence of a diseased 
mind, whereas, when all the circumstances 
of the case are known, they are easily 
seen to have had a simple origin and 
to be natural theories, efforts made by 
a common sense for some reason out of 
touch with the ordinary mind of the day 


12 MINDS IN DISTRESS 


but perfectly sound, though often highly 
sensitive. 

These wandering ghosts of ideas that have 
thus taken their rise, these theories formed 
naturally to effect a mental balance, become 
in time accepted more or less as real, and, 
instead of being corrected by a common 
sense in contact with the living moving 
world, themselves become so uppermost in 
the mind as to pervert it; so that you get the 
picture of a man who is strictly sane, and 
indeed very logical, but all whose arguments, 
with the consequences that flow from them, 
are founded on an initial theory which he 
has never been able to displace, and which 
has grown and blossomed by isolation and 
introspection. He has been the victim of 
self-suggestion, of a disorder of the attention, 
and can only be cured, as we shall see, by 
one who will completely unravel the tangle 
and at the same time place and keep the 
sufferer in the active, moving world of 
normal minds. 

The aforesaid process has nothing in com- 
mon with the genesis of the Insane mind; 
the latter is generally due to a poisoning of 
the brain tissue by some failure in the de- 


THE NORMAL MIND 13 


fensive powers of the body and the conse- 
quent absorption into the blood of poisons 
generated usually in the bowel. In fact 
the brain, like the rest of the body, is singu- 
larly tolerant of mere mishandling such as 
occurs in the cases I have sketched, and 
organic disease is a most unusual conse- 
quence thereof, though degeneration may, 
in later life, be one of the sequences. Thus 
it happens that Neurasthenia and Hysteria, 
and other mere failures of mental balance, 
may be completely recovered from after 
a course of many years, and are indeed 
often automatically cured by the choice 
advent of some overmastering idea, es- 
pecially by some very strong distressing 
experience. 

Mental balance between the common 
sense (the formed individual conscious mind) 
and all novel experience that is presented to 
it thus-means mental comfort, and the want 
of it mental distress that may, if favoured 
by circumstance, be of a most far-reaching 
kind. 

Such, in the simplest of language, is the 
psychic basis from which mental suffering 
of a functional order takes its rise. The 


14 MINDS IN DISTRESS 


symptoms that ensue depend, as to their 
character chiefly on the class of mind pos- 
sessed by the patient, and as to their extent 
on his or her circumstances in life, especially 
as to a free or a restricted contact with 
other normal minds; the active world of 
working life being the great agent that 
moulds the human mind, the common sense, 
and maintains in it a healthy circulation 
of thought and that fits it for doing its best 
work. | 

The following simple illustrations will help 
to make clear my statements. 

A. sees a ghostly figure at night. He 
knows that it is.merely a shadow picture 
thrown by a magic-lantern and is uncon- 
cerned. Or he does not know of the magic- 
lantern and is upset. His friends persuade 
him that it is an optical delusion, and as he 
finds that these are fairly common he 
accepts the theory and is at rest. Or he 
cannot accept that theory, but regards 
the figure as the ghost of a departed 
friend sent as a warning, consults spiritu- 
alists, who advise a recourse to séances to 
clear up the mystery. He agrees and is 
soon in astate of advancing ‘“‘ abnormality.” 


THE NORMAL MIND 15 


His common sense is being progressively 
perverted. 

B., a bank clerk leading a routine life and 
therefore in mental isolation, has a sudden 
_ attack of depression with fear of loss of self- 
control. It is due to a cause unknown to 
him but really quite simple, an acute liver 
congestion. Instead of consulting a doctor, 
who would have told him that such attacks 
are quite common and what they arise from, 
and that a blue pill, a Turkish bath, a little 
care in diet, and an occasional game of golf, 
would correct matters and keep him free of 
such experiences, he adopts the theory of 
incipient insanity, and by reading up the 
latter subject persuades himself that he is 
right. He gets sick-leave and further 
isolates himself. The false theory is fol- 
lowed out logically in all directions and he 
becomes at last, by incessant thought on 
the subject, and by association with sym- 
pathizers, a miserable hypochondriac. 

These examples make clear two facts of 
great importance, viz., that novel impres- 
sions which concern ourselves closely have 
a far greater effect than others in disturbing 
our mental comfort and balance, and that 


16 MINDS IN DISTRESS 


isolation favours introspection and often 
leads to the adoption of a theory which 
appears to others out of all reasonable pro- 
portion to the symptoms, for the standard 
of the isolated man is a falsified one. 


CHAPTER II 


THE MASCULINE TYPE OF MIND 


N conversation about the ordinary 

affairs of life, and more especially in 
discussions on formal topics, whether of 
politics, ethics, or art in any form, you will 
remark that educated people may readily be 
divided into two main classes: the one very 
practical, who demand proof before they 
accept a conclusion and rely only on facts, 
evidently regarding a so-called fact as a final 
truth; the other class who live in a different 
plane of thought altogether, who assert that 
the effect will be so-and-so, who see the end 
to be attained and seem to be little concerned 
with the process by which it is reached, 
and much devoted to ideals. Among the 
former will be found the plodding, steady 
people who achieve financial success, or at 
least stability; among the latter the bril- 
liant, artistic, creative and the spiritual. 
The genius is of the latter class. 

2 17 


18 MINDS IN DISTRESS 


Of course the dividing line between the 
two classes is not a hard-and-fast one; some 
have mental characteristics that are a blend 
of both types in various proportion. The 
first class is that endowed with the Mascu- 
line type of mind. Speaking generally the 
Englishman, the Lowland Scot and the 
North-Country Irishman are good speci- 
men proofs of this order, and many even 
of their womenfolk are thus mentally 
constructed. Science in all its branches 
and business in all its forms are served by 
individuals of this type of mind, and legal 
and political affairs of necessity depend 
upon it. 

It is the mind of the vast majority of 
men in this country. Without having 
studied formal logic they are logical and 
rely on the relation of cause and effect, con- 
sidering that the one and only criterion of 
sane judgment. They can conceive of no 
other valid process of thought and utilize 
it alone in all their transactions and dis- 
cussions, 

Now what would you expect to find, if 
the balance of mind be disturbed in anyone 
of the masculine type? A series of reasoned 


THE MASCULINE MIND ig 


arguments as to their state. This is what 
you find in the Hypochondriacal type of 
Depression, the Neurasthenia of the text- 
books. Throughout all his complaints the 
sufferer reasons and reasons. 

Let me give an instance: 

B., at. forty, up to three years ago engaged 
in very routine office work in the Civil 
Service. Four years ago was attacked with 
dyspeptic symptoms and occasional sick- 
ness, followed later on by an irritating rash. 
Consulted advertisement in papers and 
medical books. Decided it was _ blood- 
poisoning of some most unusual kind for 
no doctor could give it a name. Searched 
his memory and thought that he must on 
one occasion have swallowed an infected 
blood clot. Advised a rest cure at first, 
and being unrelieved, gave up his work in 
order to devote his whole mind to his com- 
plaint. Attended hospitals diligently, and 
when I saw him was covered with sulphur 
ointment, which had induced very naturally 
a general state of eczema. He presented 
me with quite a treatise on his complaint. 
Founded on the theory of the blood clot he 
had built up by strict reasoning a whole 


20 MINDS IN DISTRESS 


series of the consequences to be expected, 
and, partly by mental suggestion and partly 
by the absurd skin treatment given him by 
doctors sick of his loquacity, he had in part 
achieved most of them. The case looked 
unpromising for the whole mind was con- 
centrated on self. 

Though,not strictly apropos, I will give 
the result. I accepted, provisionally, the 
theory of the blood clot, wrote my decided 
opinion that I could cure him, and, having 
ascertained what he would accept as proof 
thereof, got rid of the eczema, put him on a 
vegetarian diet, and insisted, before I would 
proceed further, on his return to work. He 
was taken back and given an active out- 
door job by my advice. I gave him a mild 
subcutaneous injection of arsenic, which 
impressed him, and put him on his word 
of honour to consult no one, not even 
myself, and to read no medical book, for 
six months. The man is now in perfect 
health and quite sees how his former 
hypochondriasis was produced. But he 
maintains that without a definite written, 
closely-argued opinion and a written pro- 
mise of complete cure, he would never have 


THE MASCULINE MIND — 21 


succeeded in fighting his way out of the 
tangle. 

F., a prosperous city merchant, came to 
tell me that he was becoming, if indeed he 
was not actually, insane. Why the theory 
of insanity? Because he was haunted with 
an idea so absurd that no practical and 
sane mind could harbour it. He had stolen 
a pot of jam thirty years ago, but had for- 
gotten all about it, and this was the idea 
that had resurged in his mind and would 
not go. First of all I pointed out to him that 
the theft was a fact, not a delusion at all; 
that all his proofs of insanity, 7.e., some 
trifling loss of memory, extra sensitiveness, 
some sleeplessness, etc., are not complained 
of, though often present, in insanity and 
were evidently in his case induced by self- 
suggestion. Finally, that the memory of 
the theft was part of a train of thought 
induced by the words of a man in a 
heated discussion and who had. said, “F., 
you were always a thief.’ Quite un- 
deserved, this insult had rankled, and the 
word ‘ always ’’ was especially dwelt upon. 
I pointed out to him that every event of his 
past life he had recalled, balanced by his 


22 MINDS IN DISTRESS 


mind and put to rest, but the idea of this 
one little theft, actual and real, never dis- 
covered and never forgiven, had remained 
behind, isolated and unbalanceable, and 
for that reason, and just because he was a 
just and conscientious man, the idea of this 
theft stood out prominently. It was simply 
a very sane idea. 

It were easy to give instances innumerable, 
all with the same sequence. A novel idea 
or impression; a theory based thereon; 
long, logical arguments based on that theory, 
producing by their mental influence a series of 
symptoms, taken to be proofs of the theory; 
further. arguments based on these false 
proofs, and the end a tangle of reasoning 
through which cause and effect, effect and 
cause, appear and reappear in everysentence ; 
all the result of an active, sane, masculine 
type of mind struggling, by the only process 
it knows, to account to itself for a novel, and 
therefore disturbing, mental impression. 

Yet the reader will see that two other 
influences have an effect on the result. The 
sufferer in the first case had not only the 
masculine type of mind but an abnormally 
active one, and his great mistake at the be- 


THE MASCULINE MIND — 23 


ginning was to tsolate himsel}, to settle down 
to think out, to discuss with himself, his 
theory. Had he but fortified his common 
sense by a more active communion with his 
fellow-men, had he thrown himself with 
greater fervour into work and taken on new 
forms of work, he would soon have recovered 
in one way or another his balance of mind 
and with it his mental composure. 

And when we come to Neurasthenia we 
- shall see that it is the specially active, the 
high-class, and therefore the naturally iso- 
lated, kind of masculine mind that usually 
falls a victim and why it is that so-called 
rest cures or abstention from work aggravate 
the evil by favouring that isolation, thus 
rendering more remote the chances of a 
speedy cure. 


CHAPTER III 


THE FEMININE TYPE OF MIND 


HIS type is extremely difficult to 

describe. It is indeed inscrutable to 
its possessor. Its limits are not confined to 
what is usually styled the conscious brain. 
In addition to the reasoning faculty which 
it possesses in common with the masculine 
type, but upon which it by no means like 
the latter exclusively relies, it depends 
largely on intuition, on instinct, that, like 
the homing instincts of birds and animals, 
lead it aright across spaces that are appa- 
rently destitute of any guide or pathway. 
The vast majority of women have this class 
of mind, and we recognize in their deep in- 
stincts, such as that of maternity, in their 
unselfish love, in certain of their intuitive 
decisions, and in their quick insight into 
character, a faculty that guides them to a 
knowledge in which reason and experience 


play no part. Other and entirely non- 
24 


THE FEMININE MIND 25 


sexual instincts are present in both men and 
women who are of this mental type, creative, 
decorative, imaginative, spiritual in kind. 
Genius is of this order. It is there, standing 
unsupported as it were and quite escaping 
the ring-fence of any verbal definition 
founded on cause and effect. It is said to 
be a gift, another word for instinct but not 
an explanation thereof. The great ideas 
that in history have moved mankind and 
swayed destinies are products of high-class 
feminine types of mind, and while in a region 
of ultimates, where there can exist no 
standards, one cannot accord priority of 
rank, yet one may legitimately entertain 
a “‘strong doubt” as to whether the 
feminine is not the higher. The two types 
are often said to be complementary one of 
the other, though there is not much sense 
or finality in the remark. But there it is, 
the type so common in all women, and in 
both sexes of the Latin and Celtic races, and 
its existence lies at the very root of the 
great differences of opinion—the causa 
causans of the wide chasm—that prevent 
a perfect understanding between peoples. 
The masculine and feminine types when in 


26 MINDS IN DISTRESS 


different sexes blend admirably, but never in 
different nations who perpetually fail to do 
justice to each other’s motives because of 
the mental medium by which alone they 
can judge being essentially different in 
colour. 

What about this wider, deeper, feminine 
type of mind, this mind that does not de- 
pend solely on the grey matter of the brain 
as its basis but embraces the unconscious 
portions—and remember we have no right 
to rank either part as a higher one—when 
it loses balance? 

Not the ordered argument, not the re- 
cords of hours and days devoted to intro- 
spection, to a logical ordering of each section 
of a mental problem; not the reliance on 
cause and effect as with the masculine 
type, but an upheaval of wide extent, a 
volcanic eruption, a mingling of capricious 
thought and of disordered or convulsive 
action. That is what you would expect, 
that is what you get, and it is called 
Hysteria. 

At this point again I must add, to avoid 
possible misunderstanding, that though, for 
the sake of clearness, I describe the two 


THE FEMININE MIND 27 


types of mind as widely separate yet in 
actual life they are often blended, scarcely 
ever perhaps in equal proportion; one type 
is usually recognizable as predominant but 
instances of pure type are by no means 
rare. 

How does the great rule of mental balance 
affect the feminine type of mind? In the 
masculine type we had a comparatively 
simple problem that lent itself kindly to 
definition. Simple reason, as codified by 
formal logic and as applied every day in 
our business occupations and our scientific 
studies, in a state of distress, seeking by a 
fundamental rule of the mind to recover 
the balance of health and borrowing a 
counterbalance, 7.e., throwing out a theory, 
to that end, but often coming to grief by 
an excessive reliance on its own strong 
virtue, pure reason; the wanderer being 
further confused by the extravagant terms 
and theories of the guides to whom he 
applies for direction, like Sganarelle in 
his interview with Pancrace, doctor zz 
utrogue jure, in the “ Mariage forcé”’ of 
Molicre. 

The feminine type of mind is, like the 


28 MINDS IN DISTRESS 


masculine, and like every human mind, the 
result of a balance between the two parts 
thereof; an individual mind made up of 
impressions and ideas constantly being 
formed and a common mind (common 
sense) which represents the sum of acquired 
knowledge, plus certain instincts, the latter 
being the main element in the feminine type 
and which may be said to permeate it. 

Under natural conditions, that is under 
such as afford scope for its full satisfaction 
and development, the feminine type of mind 
passes through life in a state of health. Its 
equilibrium is always a more delicate one 
than in the other type but small disturbances 
are rectified by the emotions acting as safety 
valves. How often do we not see a flow of 
tears in a woman or in a man of the Latin 
race bring relief to mental tension of the 
most varied kinds. 

The disequilibration of the feminine type 
which we have later to study under the name 
of Hysteria varies of course as widely in 
its forms as the mind from which it has 
sprung, and will be seen to arise usually from 
two great causes—a repression of instincts 
and an exaggeration of self. 


THE FEMININE MIND 29 


Now instincts are never clear in conscious- 
ness. Take the maternal instinct: many 
women are never conscious of it, others feel 
it only as a vague impulse towards some 
end, and very few women ever devote serious 
thought to it, as they would to a problem in 
science. In civilized countries, where the 
masculine type of mind almost alone makes 
the laws and largely the social customs, all 
instincts have to be somewhat repressed, if 
they threaten to obtrude themselves unduly 
on public attention; for reasoning power 
must always have the most prominent 
position as controlling agent; and this is 
beneficial, for the mind, like the body, 
gtows in strength as it grows in ordered 
self-control. 

For if the bringing-up of a girl has been 
such that all the trivial cravings of the child 
mind for the indulgence of self have been 
unchecked; if in adolescence wealth has 
gratified every one of the increasing, though 
in essence natural, desires for excitement, 
for self-adornment, for self-advancement 
and self-prominence in every shape; if 
the Ego has been thus allowed to take the 
chief, almost the only, place in the woman’s 


30 MINDS IN DISTRESS 


common sense (7.¢., common mind), what is 
the inevitable result? 

The common mind is stored with all that 
relates to self and takes up readily (in the 
balance) only those impressions and ideas 
which relate to self; and you have a com- 
pletely self-centred individual, a mind iso- 
lated because it does not find in the world 
those with which it can, or cares to, com- 
municate. | 

Though in no sense of the word an insane 
mind, its vision of everything (when the 
mind makes itself up) is distorted. It 
honestly does its best often to see, to be 
persuaded to other people’s views, but, like 
a person with bad astigmatism, it cannot 
with the best will in the world see straight 
lines where others see them. 

To such an egoist comes suddenly a grave 
disappointment. That which it ardently 
desired is out of reach or is lost; the balance 
is disturbed. Not only the reasoning 
faculty, as in Neurasthenia, but the sub- 
conscious and unconscious portions of the 
mind are thrown into violent disorder; the 
weakened moral powers, the debilitated, 
insufficiently exercised intuitive powers of 


THE FEMININE MIND 31 


the mind give way and disorganization 
reigns through every part of the body. 

And, pathetic as it is, you can often see 
in the midst of this mental and physical 
chaos the old pampered Ego fighting hard 
for first place. 

Such is the genesis of Hysteria. The un- 
balancing of the feminine type of mind, of 
the mind that has as its physical basis not 
only the grey matter that envelops the 
hemispheres of the brain, with which acute 
active consciousness is associated, and which 
is concerned mainly in the weighing of 
cause and effect; but also the white matter 
beneath it, with which the instinctive and 
more spiritual mind is connected, disturb- 
ance of which, if great, may involve even the 
centres of the lower brain and bring under its 
deranged mental control many functions 
which, in ordinary life, are beyond will 
power .and automatic in their action. I 
have seen a hysterical patient at will reduce 
in five minutes the action of her heart from 
88 to 18 beats a minute; and another take 
a large bowl of bread and milk and, at my 
command, arrest the food at the end of the 
cesophagus and return it at a signal, un- . 


32 MINDS IN DISTRESS 


altered, into a basin; or, if I ordered it, allow 
the food to pass direct into the stomach and 
at a given signal reject it, altered by the acid 
secretion of the stomach. Under strict 
conditions precluding imposture I have seen 
the body temperature sent up as much as 
7 degrees in the course of half an hour, 
whilst paralysis and wasting, phantom 
tumours and a close imitation of every 
known disease, are quite the commonplace 
phenomena in hysterical patients at every 
hospital. Through one and all of these 
manifestations the prevailing egoism of 
the patient is generally apparent, and this 
has led to the belief, now known to be 
erroneous, that wilful effort is always con- 
scilously at work. This is not so; the 
patient is always herself deceived, though 
she may consciously add to her symptoms 
in her craving for attention and sympathy. 

The one instance to which space restricts 
me is that of a man whom I knew as a 
patient for nearly thirty years. 

In business, and aged about thirty when 
I first met him, he had considerable artistic 
taste, was emotionally religious, had some 
literary pretensions, was always en pose, 


THE FEMININE MIND 33 


and was fond of asking people what, from 
his appearance, they would judge him to be, 
delighted always if the reply was a doctor, 
an editor, or a clergyman. Vain and self- 
important, he was always having his char- 
acter written and quoting the laudatory 
paragraphs. He would discuss himself and 
his symptoms for hours, with gusto. He 
had, in succession, partial blindness, com- 
plete deafness and functional paralysis of 
several kinds. If he were crossed in any way 
he would have violent hysterical convulsions 
with aimless violence ; while he took business 
reverses (he failed more than once) with 
placidity. After one of his later reverses 
he travelled round the world en prince, 
leaving his family to work their way out 
of his financial troubles. He lectured, and 
even wrote books about his travels, and, to 
his delight, obtained later a small literary 
post. -He then had thoughts of purchasing 
a D.D. or LL.D. of some moribund Ameri- 
can university. His end was characteristic. 
In a hysterical seizure he drew a penknife 
across his neck (not the first time he had 
inflicted superficial wounds on himself), and, 
though the cut was insignificant, it sufficed 
3 


34 MINDS IN DISTRESS 


to open the external jugular vein and he 
died of an air embolus in consequence. 

He interested me greatly because, being 
intelligent and observant, he could give me 
—and did it with great delight—a good 
description of his various mental states. 
He was never hypochondriacal, and never 
alarmed about insanity, although he was 
conscious that his mind was occasionally 
out of accord with those of others. That to 
him was proof of superiority. He kept an 
exact register of all his thoughts, feelings 
and motives, especially of those that led 
up to and accompanied an acute attack. 
They would have filled several volumes 
and showed the possession of remarkable 
intuition in estimating the characters of 
others and many traces of real genius. He 
was an only child of very emotionably 
religious people, who destined him for the 
ministry and encouraged him, when a youth, 
to compose hymns and write sermons, and 
this early exaltation of his Ego unbalanced 
an otherwise fair specimen of the feminine 
mind type. 

Resumé.—Under the simple analogy of 
a balance we see the fundamental process 


, 


THE FEMININE MIND 35 


concerned in making up one’s mind, and how 
essential it must be for mental health and 
comfort that our common sense should be 
fed with the impressions and ideas gathered 
from as wide a range of experience as pos- 
sible. If the mind be nourished—as a 
result of faulty upbringing or by the force 
of circumstances—by an undue proportion 
of ideas that have relation to the self and 
its gratification, or indeed by one set of ideas 
of any kind, it falls unconsciously more and 
more out of touch with the general mind of 
the day (the Zeitgeist) and becomes isolated 
and may be keenly conscious of such isola- 
tion from which it cannot, unaided, escape. 

When in this condition if it be balked in 
any of its extravagant and selfish aims, or 
even if the most natural of its instincts be 
denied to it, the result in the wide feminine 
mind type will show itself in extensive and 
manifold derangements (Hysteria), while in 
the reasoning masculine type any novel and 
unbalanceable idea or impression will pro- 
duce a “theory ” on which reason will 
construct a superstructure of dreads and 
terrors (Neurasthenia). 

And I purpose to show in the following 


36 MINDS IN DISTRESS 


chapters that the line of treatment is to take 
possession of—to impose one’s will upon— 
the isolated mind and by suggestion (which 
may operate through various agents) to lead 
it back to contact with the general mind of 
humanity. That efficiently done, the cure 

will complete itself. | 





CHAPTER IV 
NEURASTHENIA 


z.e., loss of balance in the masculine type of mind 


(Synonyms :—Hypochondriasis, Psychasthenia, Nervous 
Debility, Nervous Breakdown, Depression, etc.) 


HAVE adopted on the lucus a non lucendo 

principle and with a sole view to clear- 
ness, the best known of the above question- 
begging designations, Neurasthenia; for, as 
we have seen, the disorder is not due to 
nervous weakness but to the strictly normal 
activity of the mind in efforts to restore 
the balance in which mental health and 
comfort consist. 

For-just as the body maintains its balance 
in health by the ordered co-operation of all 
its organs, and, health being lost, sets in 
action certain phenomena (known as the 
symptoms of functional disease) with the 
sole object of the restoration of its equili- 
brium (which tendency used to be called the 

37 


38 MINDS IN DISTRESS 


Vis Medicatrix Nature), so the mind in a 
like state of instability directs her activities 
to a like end, 7.e., a restoration of balance. 
In the mind, as we have seen, the cause 
of disturbance must be some circumstance, 
represented by impressions or ideas, to which 
the mind is unaccustomed and which it 
cannot therefore readily balance. These 
are either sensations which generally take 
their rise in some one of the abdominal 
organs, such as the liver, stomach or sexual 
apparatus, which have but very indirect 
connection with the highest brain centres, 


or certain strange ideas, that have a bearing © 


on one’s welfare, and which, because of their 
novelty, cannot be connected with any of 
our usual trains of thought and assimilated, 
1.€., balanced. 

Predisposing Causes of Neurasthenia.—The 
books give to heredity a prominent position 
among these, but its influence, according 
to my own statistics of about 800 cases, is 
negligible in Neurasthenia. The mistake 
has, I think, arisen from the common con- 
fusion of this disorder with Hysteria, in 
which a hereditary predisposition to in- 
stability is a strongly-marked feature. 


NEURASTHENIA 39 


As regards overwork, I unhesitatingly 
affirm that the influence of genuine, whole- 
some, all-round work will be found, on 
critical examination, to be very slight; 
though it is the favourite cause assigned by 
the patient. The classes of work that are 
baneful, even in moderation, are those that 
keep the individual out of active communion 
with his fellow-man, or that actually deprive 
the brain of work; such are routine employ- 
ments, and those that offer no sufficient 
prize as stimulus to individual thought and 
enterprise, and those which necessitate the 
long habitual use of one or a few only of 
the mental faculties. To be health-giving, 
work must be varied, must necessitate free 
intercourse with other minds, and must 
provide that carrot in front of the donkey 
which alone can make it progress with alac- 
rity. To the deadening effect of unsuitable 
work; even more than to the want of physi- 
cal exercise, breakdowns are due. Co-opera- 
tion from the active interest it generates 
in the workers’ minds seems to me to have 
great possibilities in the prevention of all 
varieties of nervous disorder. What about 
worry? Its effect depends much on the 


40 MINDS IN DISTRESS 


situation and the personality. I have 
known cases in which it had a curative effect 
as a stimulant, a way in which some great 
disaster will often act—pulling a man to- 
gether, deciding him to new and more 
vigorous effort. But in blind alley employ- 
ments, and there are many such, worry 
may act as the final straw to the over- 
burdened camel; but, as I have said, it is 
not possible to lay down any rule for every- 
thing depends on the kind of worry and the 
predisposition of the mind. Whatever tends 
to produce isolation of mind is the one great 
antecedent condition to Neurasthenia. As 
long as even the most unstable of minds 
keeps itself among the crowd and is “ in and 
of the world ”’ it is on safe ground and in the 
most favourable state to regain any foot- 
hold temporarily lost. In proportion as 
you fail in contact with general humanity 
you admit self to too large a share in 
the common sense (common mind), every 
day opening the door wider to the Ego till 
at last it becomes master therein; and when 
that is the case the most trivial of impres- 
sions and ideas, as long as they have any 
bearing on self, become magnified in im- 


sg 


Byes iON COLLEGE: 


Pett ene) y . y 
CHESTNU i iii WASS 


NEURASTHENIA re 


portance until more or less everything that 
takes place comes to be regarded as having 
direct reference to self. This is the hermit 
mind, and it is the mind of nearly all 
Neurasthenics and of all Hysterics. I 
have known a man of splendid physique 
and accustomed to command rendered 
so self-conscious by prolonged isolation 
as to experience acute feelings of self- 
abasement in passing chattering workmen 
who were, as he imagined, engaged in 
criticizing his appearance and motives. 
Every reader who has suffered at all from 
Neurasthenia will understand how such a 
state of matters can come about. Most of 
the men who pass as proud and distant are 
sufferers from some form of Neurasthenia. 
They feel their isolation keenly but have 
become so abnormally sensitive that they 
cannot face the only remedy, the health- 
giving plunge into the great sea of humanity. 
Yet this isolation, which has such painful 
consequences, is rarely the fault of the 
sufferer, for, exclusive of those in whom it is 
engendered by the nature of their employ- 
ment, it is usually the outcome of close 
application to study and most men of letters 


42 MINDS IN DISTRESS 


and science experience it to some degree. 
/ Uheir devotion to a special line of work 
[ leads them unconsciously into the back- 
\ waters of life, and thus we often observe 
< that really great men are exceedingly 
| shy and reserved simply because they are 
neurasthenic, while the lesser fry, who have 
as motto “‘ Ad majorem Mei gloriam,”’ and 
~self-advertisement as their object, tend to 
Hysteria quite as often as to Neurasthenia 
when their minds are off balance as a 
/ result of isolation. Thus Neurasthenia 
has come to be viewed as the malady 
-of superior intellect. ‘Spiritus altos 
frangit et generosos,’”’ said old Burton, and 
in truth its victims among the thoughtless 
and uneducated are by comparison very 
few. 
- Strain and Stress must be reckoned among 
the predisposing influences. Puberty and 
the climacteric are the great natural periods 
of strain, and, as we shall see, sexual 
Neurasthenia is one of the most common 
disorders of young and vigorous men, while 
the many mental disturbances attending 
puberty and the climacteric in women 
assume, according to the type of mind of 


NEURASTHENIA 43 


the sufferer, the form either of Neurasthenia 
or of Hysteria. 

Thus nerve weakness and mind weakness 
are in their whole development course and 
termination the very opposites of what we 
see in the diseases that still, in borrowed 
Greek garb, pass under their names, for 
nervous weakness involves real prostration, 
as you see in the worst stages of such acute 
diseases as typhoid fever and pneumonia, 
while mental weakness—Psychasthenia in a 
literal sense—is the characteristic of ad- 
vanced brain disease and of senility. The 
Neurasthenic, using the term in our sense as 
indicative of mental instability, will indeed 
volubly assure you that he cannot stand 
upright; that he falls down after walking a 
few steps; that he cannot concentrate his 
mind on work; that the labour even of 
dressing himself is a formidable one; that 
he cannot recollect sometimes the most 
familiar names; in short, that his mind 
is going if not actually gone; but if you 
measure his total output of energy you will 
always find it 7m excess of the average, but 
extravagantly used, misdirected and dis- 
sipated in irrelevancies of thought and 


44 MINDS IN DISTRESS 


action, tangled and confused to such a 
degree that endless patience and full know- 
ledge of the individual and of his environ- 
ment, and above all tact, are essential to the 
adviser who would undertake the responsi- 
bility of his direction. Is not the sufferer 
also perverse? Yes, and adverse to such a 
degree that a learned German has recently 
issued a pamphlet on Neurasthenia and 
kindred mental states, entitled Zur theorie 
des Schizophrenen Negativismus. Schizo- 
phrenic Negativism! What a name for the 
negative attitude which, by the way, is, 
under the circumstances, the only logical 
one in Neurasthenia as seen from the 
patient’s standpoint. Resting, as we are all 
bound to do in unusual experiences, on the 
best theory he could find, he has logically 
built thereon a superstructure of disease, 
‘has generated by this mental bias many 
symptoms which tend to confirm him in the 
truth of his original theory, and, running 
in such grooves, he is suddenly countered by 
the blunt statement that he is altogether 
wrong by a doctor who thinks to carry the 
aforesaid strong position by a direct frontal 
attack. Try such strategy on the one-idea 


~ 


NEURASTHENIA 45 


man (the faddist) or on the doctrinaire socia- 
list who dreams of a stable social balance, 
not knowing that in individual mind as in 
nations the very oscillations of the balance 
are life itself, and you will find plenty of 
Negativismus. No; if you are to prevail 
with the settled Neurasthenic you cannot 
expect often to succeed by a coup de matin 
but must be content with some slower pro- 
cess, such as that of “‘ running a parallel,” 
after having first carefully mastered the 
processes that have led to his present 
state, and appraised the strength and dis- 
position of the forces in opposition to you. 
Let me give an instance of the use of such 
a parallel. A man, about thirty, a noted 
athlete, in perfect physical condition, in 
low, solemn tones complained of Syphilis. 
His conscience was clear but he had a pimple 
on his leg which he pointed to as the seat 
of infection. His physical strength was 
his great asset and his mind always directed 
toits maintenance. Having had to undergo 
medical examination in view of some ap- 
pointment, the examiner had remarked that 
the pimple looked like the initial character- 
istic papule of Syphilis. Mercurial treat- 


46 MINDS IN DISTRESS 


ment was started, and, aided by self-sug- 
gestion and vigorous skin friction with blue 
ointment, an eczematous state of the skin 
soon ensued. This, with other trivial symp- 
toms, confirmed the patient in his fears. 
It was impossible to shake them. I then 
wrote on a piece of paper that I proposed to 
deceive him, placed it in a sealed envelope 
and gave it to a friend of the patient who 
accompanied him, telling him to keep it and 
return it to me unopened when I demanded 
it. I then said to the patient: “A clear 
case of rag-picker’s disease (anthrax), in- 
fection probably arising from contamination 
of your clothing in some country laundry; 
if you read up the disease you will see that 
I am right. You will get quite well.” In 
the absence of the mercurial frictions the 
eczema disappeared promptly, but a vigo- 
rous cough (a minor symptom of rag-picker’s 
disease) developed. In a month, when the 
idea of Syphilis aroused only indignation in 
the patient’s mind, I asked his friend to 
hand me the sealed letter. The patient 
read it and was delighted. He remained 
well and readily forgave the innocent 
deception. Was I not justified by my 


NEURASTHENIA 47 


Hippocratic graduation oath, a paragraph 
of which runs thus: ‘“‘ Et quoad potero, 
omnia ad egrotorum corporis salutem 
conducentia cum fide procuraturum ’’? 
It is a characteristic of Neurasthenia 
that the victims are generally in excellent 
physical health. Organic disease is rare 
even in inveterate cases, and when present 
has no part in the production of the mental 
complaint; a statement strictly true and 
easily explained, for although the patient 
is keenly concerned about his health, this 
concern is concentrated only on such dis- 
turbances of it as he cannot account for, and 
in these only can his mind reach no condition 
of equilibrium. Those which are visible, 
tangible and comprehensible, such as the 
organic diseases, not only does he meet with 
ordinary courage but often with indifference. 
Indeed, with the advent of organic disease 
Neurasthenia and Hysteria take their tem- 
porary departure, and so generally recog- 
nized is this that I have several times 
been asked by patients to inoculate them 
with the microbe of some definite disease 
because they preferred known dangers to 
the ghosts and shadows of disease that 


48 MINDS IN DISTRESS 


haunted their minds. Influenza is often 
cited as an example to the contrary, but 
that disease is itself often vague in its 
symptoms and thus might legitimately come 
under the heading of novel impressions that 
are recognized causes of Neurasthenia; but, 
as a fact, the muscular and nervous debility 
that accompany and follow Influenza can 
but rarely be justly styled a real Neuras- 
thenia with its attendant bogies and multi- 
form complications. 

There is no more common disorder than 
Neurasthenia, but it occurs so frequently 
in mild and transient forms, and seems to 
the victim so unreal and so inexplicable, 
that he hesitates to consult his friends, or 
even the doctors, and its existence is known 
only to himself, for, strange as it may seem, 
the Neurasthenic, later to haunt to his 
detriment many consulting-rooms, at first 
puts little faith in physic. There may be 
several reasons for this. I speak with the ex- 
perience of a sufferer from this malady from 
thirteen to forty-one years of age, and of 
one who up to twenty-six years of age spent 
very considerable sums in fees, seeking relief 
therefrom and with very unsatisfactory 





NEURASTHENIA 49 


results. I longed to explain and to be under- 
stood, but was barely listened to. The 
diagnoses varied widely, from imagination, 
whatever that might mean, and liver dis- 
turbance, to incipient insanity, and the treat- 
ment was uniformly one with tonics, such as 
Strychnine, Quinine and Phosphorus, all of 
which aggravated my symptoms. One 
-only—and he a homceopath—gave me a 
white crystalline powder, evidently, from 
what I now know, a bromide, which did 
relieve remarkably, but he demanded such 
an extravagant sum for the prescription that 
it was beyond my power to purchase it. In 
the midst of my worst attacks I was always 
in excellent general health and capable of 
walking thirty milesaday. It left me finally 
when I had the misfortune to be infected by 
a hospital patient, on my right index finger, 
with a severe and very chronic disease, and 
I can truly say that the exchange of diseases 
was a pleasant experience. 

Many of the mild cases get well spontane- 
ously, and even many of the severe ones pass 
off quickly under the restorative effect of 
the hard work that is required of most 


men in this world. Some find the power to 
4 


50 MINDS IN DISTRESS 


endure it till it vanishes by some change in 
their life or by some sudden adversity—for 
adversity however great is tangible and 
therefore steadies the mind. Courage and 
fortitude are of enormous assistance in 
recovery. 

One charming old lady, for forty years 
the re-elected head of a religious community, 
gave me an account of the exceptionally 
severe and prolonged sufferings she had 
formerly endured. When I inquired as to 
treatment she replied simply that being 
the Will of God she had bowed to it and 
gone ahead at her work. She had found the 
philosopher’s stone. 

So important is it for the patient to re- 
member that in work, even severe work, 
lies the best road to recovery, in all but a 
very few cases, that I need offer no apology 
for quoting one more individual experience. — 

In 188— I had a severe attack; the feeling 
of isolation from the rest of humanity, the 
sense of “‘ unreality ” in surrounding objects 
being most keen. The fear that I should 
suddenly lose self-control was ever with me, 
my special bogy being a fear lest I should 
be forced against my will to commit suicide 


NEURASTHENIA 51 


or some crime of violence. (To this obses- 
sion of suicide is, I find, traceable the 
popularity achieved by the safety razor.) 
Like most sufferers I slept and ate well. 
An eminent neurologist advised a walking 
tour down the Loire. I went, and for the 
three weeks it lasted suffered untold agonies, 
often begging the friend who accompanied 
me to place me safe in an asylum. I re- 
turned to London looking ill and worried, 
and was told by the same consultant to 
take at least six months’ rest, and on no 
account to return to practice. My assistant, 
when informed of this, replied that I could 
take that holiday only when I had seen a 
number of people waiting to consult me. 
The next ten days were days of almost cease- 
less night and day work, but I was absolutely 
well ere they passed and remained perfectly 
free from any return for several years. 
Nothing is more frequently seen in the 
daily papers than the statement that severe 
depression had preceded an attempt at 
suicide, and the idea has become quite 
general that neurasthenic states (nervous 
breakdowns) may lead to a tragedy. No- 
thing is further from the truth. Melan- 


52 MINDS IN DISTRESS 


cholia, an insane state marked by delusions, 
silence, and general mental torpor, is of 
course a frequent precursor of suicide, 
but Melancholia is the very opposite of 
Neurasthenia, and of anything that can 
legitimately come under the latter designa- 
tion. To clear this point, in which I was 
myself secretly interested, I made it a duty 
to interview several people who had made 
determined, but fortunately ineffectual, 
efforts at self-destruction. Strange to say 
all were, after recovery, willing to explain 
their state antecedent to the attempt. 
There were five such cases and in not one 
had there been any prior fear of the act nor 
any neurasthenic condition of mental suffer- 
ing. Two said that they were dazed and 
oppressed, and neither thought nor cared 
about the consequence of their act; the 
other three that the act seemed at the time 
quite the most natural thing to do. I have 
never known of a case in which Neurasthenia 
or any allied condition led to self-destruction. 
The fear of it in the Neurasthenic is indeed 
keen but is the dread of a dread, though 
when, as sometimes happens, some drug 
habit has been contracted by the sufferer 


NEURASTHENIA 53 


he may deliberately destroy himself. This 
however is due to an unwise attempt to 
suddenly and completely break the bonds 
of drug slavery, and the consequent unen- 
durable suffering, or to despair at his failure. 
In Hysteria, as we shall see later on, the 
drama of suicide is often enacted as a 
comedy but may be overdone and end in 
tragedy. | 

The Bogy (or Obsession) in Neurasthenta.— 


The most outstanding feature in Neuras- 


thenia is the dogy (the phobia of the text- 
books). Given an intimate knowledge of 
the patient’s modes of thought and general 
life, his bogy may be foretold with accuracy. 
Nothing impresses a sufferer more than this 
proof of the doctor’s foreknowledge. It is 
arrived at very simply, for it represents, of 
course, that which is most abhorrent to the 
particular patient, being in its essence only 
a supreme dread. The bogy represents 
the theory (the counter-weight adopted 
for purposes of mental balance) formed to 
account for novel impressions and ideas of 
which the causation is not apparent to the 
mind, or some logical deduction from that 
theory, and it always relates to self. Injury 


54 MINDS IN DISTRESS 


to mind or body, to self-love or reputation 
is the basis. The Bogy of insanity has its 
source in forms of mental discomfort such 
as the dream-like or fog-like sensation, or 
the feeling of isolation, or the apparently 
threatened loss of self-control and conse- 
quent involuntary suicide or crime. One 
form of train fear and ship fear is based on 
this. The Bogy of sudden and violent death 
is connected with fear of open or of confined 
spaces, of water and of fire. The Bogy of 
disease 1s not quite of the same class. 
Suffering or disfiguration, and the risk 
of becoming abhorrent to humanity, are 
dreaded, but any fear of death in the ordi- 
nary way is rarely acknowledged by Neu- 
rasthenics, and, whatever be the disease to 
which they eventually succumb, it must be 
acknowledged that they meet death with 
calmness, failing to realize that it can be 
unaccompanied by the horrors which in 
imagination they have attached to it. 
One of the worst cases I ever attended—a 
man who for years varied his bogy almost 
every week though all had the fear of some 
disease as foundation—when dying of dropsy 
due to heart disease of old standing, loudly 


NEURASTHENIA 55 


intermitted the remark, ‘That is d 
nonsense,’ when the clergyman referred 
to him in prayer by his bedside as “ our 
dying brother.” The Bogy of injury to 
self-esteem is at the bottom of that jealousy 
which haunts some Neurasthenics even 
while they carefully explain the baselessness 
of the obsession which they cannot shake 
off. The Bogy of loss of good repute is 
often put in some one of the following 
‘ways: “‘Suppose I were to enter a rail- 
way carriage and an old man were to 
get in at the last moment and I were to 
lose self-control and attack him. Imagine 
my disgrace as a commercial traveller known 
all down the line.”’ Or, “ Suppose a clerk in 
my office happened to be in the Strand at 
a moment that I turned round and that 
he thought I was looking at a loose woman. 
Imagine the ridicule at my place of busi- 
ness.” - Or, “‘Suppose I, in a sudden loss 
of self-control, put poison into a water- 
bottle in a public waiting-room, and that 
it killed someone, and that my act had been 
observed. Imagine my situation as a pro- 
minent member of the Bar.” Far-fetched 
and absurd as such fears may seem to the 





56 MINDS IN DISTRESS 


sound and healthy they are quite ordinary 
forms of self-torment to men of intellect 
and who are perfectly and absolutely sane 
but Neurasthenic. 

A large volume might be written solely 
on the hues assumed by different bogies. 
They are as various as the occupations and 
minds of the sufferers, but never are they 
in any sense of the word delusions but 
always and only fears founded on theory. — 
There is a special prominence given to the 
numbers 3 and 7 by many neurasthenic 
minds and which is difficult adequately to 
account for, but the origin of the idea is 
probably theological and based on the 
Trinity, the seven mortal sins, and the 
Seven cardinal virtues. 

And here, for the relief of any Neurasthenic 
reader, [ may answer a question often put 
to me in great anxiety: “ But what would 
happen to me if I actually lost my self- 
control?’’ The answer is, an hysterical 
paroxysm. The feminine mind, never 
acutely concerned about consequences, 
makes no effort, in the condition of strain 
felt so acutely by neurasthenic masculine 
minds, to inhibit or restrain itself, but simply 





NEURASTHENIA = 


lets itself go and explodes in tears, shrieks 
or muscular contortions before the stress 
becomes unendurable, while the masculine 
mind in Neurasthenia, dreading possible 
disaster, or at least ridicule, keeps a firm 
hand on its strange impulses and suffers 
acutely in consequence. The feeling is like 
that experienced in a trotting race when you 
require all your muscular power to keep the 
horse from breaking into a gallop and fear 
every moment that he will overpower you. 

I have more than once seen this state of 
tension end in hysterical sobbings and con- 
vulsions in emotional Neurasthenics, and 
have remarked that it brought quick relief; 
but one cannot recommend it in treatment 
since self-control is a rare enough virtue 
and one to be encouraged most of all in the 
victims of such mental disequilibration as 
we are discussing. 

But-the reader must not conclude that all 
cases of Neurasthenia or of Hysteria are 
typical like those I have selected for illus- - 
tration. In minds more or less com- 
pounded in varying proportions of the 
masculine and feminine types of mind 
Neurasthenia and Hysteria may touch or 


58 MINDS IN DISTRESS 


even overlap at certain points, but no two 
disorders in pure mind types are in their 
leading characters more distinct. 

A clear and intimate knowledge of the un- 
derlying causations and the many ramifica- 
tions of Neurasthenia is essential to the man 
who would treat the disease with success, 
and only the doctor who has himself suffered 
can fully understand the language of the 
patient and appreciate the sufferings that 
attend this, the most painful, and, in its 
origin, the least understood of disorders. 





CHAPTER V 


THE TREATMENT, ETC., OF 
NEURASTHENIA 


HE following are the essential points: 

First and foremost, no time or pains 
must be spared in obtaining a clear mental 
picture of the patient, avoiding of course 
all irrelevant details. A good plan is to 
shut the eyes and to let the patient talk, 
even if he consumes an hour or two in 
the process. Nothing 1s unimportant. Ap- 
parently trivial matters often furnish useful 
guides. You thus obtain a map of the 
disorder, and view its source, and all that 
has contributed to its development. You 
further note the points on which your attack 
may be directed. 

It is a mistake to stop the patient; let 
him unburden himself and give, unchecked, 
his opinions. By so doing you learn his 
motives and his reasons and note the way in 
which his mind naturally works, and as you 

59 


60 MINDS IN DISTRESS 


will have to work with him, it is essential 
to obtain this knowledge so that your treat- 
ment may commend itself to his judgment. 
We must have no more Negativismus than 
we can help. 

Secondly, having pumped him quite dry, 
a most careful physical examination must 
be made and full notes thereof taken; no- 
thing should be left out lest the omitted 
part assume later on to the anxious patient’s 
mind the probable place of origin of his 
malady. Often in past days has the 
patient said, ‘‘ You have taken no blood 
for analysis,’ adding significantly, “I 
think you will find the disease there.’ 
Therefore, however apparent be the under- 
lying cause of his complaint to yourself, 
you cannot afford to skip any part of the 
examination. 

I always take my own specimens and 
submit them to well-known skilled analysts, 
and ask the patient to post them, allowing 
the report to be sent direct to him if 
any preference for that course be shown. 
Neurasthenics, without meaning any offence, 
are often very suspicious. 

In three or four days, when the reports 





4 
‘ 
7 
7 
q 


NEURASTHENIA 61 


have come in and been considered, I ask the 
patient to call and hand him my written 
opinion. 

This written opinion—with the reasons 
on which each conclusion is based—is the 
keynote of treatment. It shows the 
patient that you are sure of yourself, and 
in the present day, with our many aids to 
diagnosis, a careful man is fully justified in 
self-confidence. This document is a great 
stay to the patient in the moments that are 
sure to come when old doubts will reappear. 
I have had proof of its efficacy in the many 
cases in which the decided tone of the 
opinion has alone kept the patient to the 
line of safety when verbal advice had faded. 
One lady indeed thus reproached me: 
“Why didn’t you write that letter at first 
instead of saying, ‘In my opinion you will 
get well.’’”’ Even long after they have re- 
covered patients will keep such a letter and 
feel a security against relapse in its occasional 
reperusal. 

Thirdly, deal with the Bogy. To: fore- 
tell the bogy to the patient is to rob it of 
much of its importance and appearance of 
solidity. But though you may thus sap 


62 MINDS IN DISTRESS 


its credit you must not at once proceed to a 
direct attack on its person. On the con- 
trary, sometimes you must run a counter- 
attraction, a rival; sometimes you may 
pull the bogy to pieces bit by bit, or again 
you may dig the ground from under it. 
Charge it in the open, as hypnotists so 
often do, and you will come off a very bad 
second, and you cannot afford any reverse. 
Many cases of Neurasthenia are of a very 
chronic type and in them the bogy may 
be too firmly “set”’ to yield to any of the 
aforesaid measures. In these I find great 
help from an “ Infallible.’’ Now an Infallible 
is a medicine that cures without being taken, 
a formula of great mental potency, but com- 
posed of real drugs capable of actually and 
really displacing the enemy, but which it 
would be unadvisable for the patient to 
take regularly. Therefore the prescription 
is marked “‘ Emergency only,” and is care- 
fully guarded by the verbal direction: 
“Take a dose of this only if you feel that 
you have come to your last ditch.” Now 
the typical Neurasthenic, being an anxious 
man, says to himself in an emergency: “I 
will not take this medicine lest it should 





NEURASTHENIA 63 


injureme. The doctor told me that, though 
certain in effect, it was a little risky by reason 
of its potency.” Or again: “If I take a 
dose and it fail my last hope will be gone, 
I will reserve it for a still worse attack;”’ 
and one peculiarity of all crises in which 
the bogy plays the principal part is that 
they cease just before they become absolutely 
insupportable. The following will illustrate 
this point. A friend and patient agreed to 
undertake, by my strong advice, a voyage 
to Japan, but though in excellent physical 
health—despite a stay for months in various 
northern nursing homes which had converted 
a passing Neurasthenia, to which he was 
subject, into a confirmed state of auto- 
suggestion with threatening paralysis as 
the bogy—he was most nervous about 
leaving London. He was given an Infallible 
with the usual directions, and on returning 
to England he placed the bottle, still sealed, 
on my mantelpiece with the remark: “‘ That 
medicine cured me though I never drew the 
cork.” 

Fourthly, work must be insisted on. A 
man’s usual occupation, if it be at all con- 
genial to him, and if it provide abundant 


64 MINDS IN DISTRESS 


means of meeting and conversing with his 
fellows, is the best. It should be of a kind 
that, once started, means compulsory regu- 
larity and attention. All other measures 
will fail until you have secured this essential 
to success. In nine cases out of ten it is the 
only treatment necessary. Of course you 
will find it hard to persuade the patient to 
this salutary course. He will object, ‘ You 
make me well and I will return to work,” 
putting the cart before the horse; or, “I 
shall die if I work,” but ‘‘I will work if I 
die,” is the view that you must insist on. 
The benefit of work is so obvious that one 
is puzzled to account for the “rest cure’”’ 
fad unless it arise from a refusal of battle for 
the sake of the adviser’s peace and quiet. 
Eminent writers from the dawn of litera- 
ture, most of them sufferers, are absolutely 
unanimous on the benefit of work in all 
neurasthenic states. ‘“‘In idleness alone 
is there perpetual despair,’ said Carlyle. 
Galen called idleness “‘ Maximum animi 
nocumentum.” ‘“‘ This body of ours, when 
it is idle and knows not how to bestow itself, 
macerates and vexes itself with cares, griefs, 
false fears, discontents and suspicions, and 





NEURASTHENIA 65 


is never at rest,” adds Burton, and one 
might continue similar quotations ad 
infinitum. 

You may very occasionally meet a Neu- 
rasthenic who may need rest for some good 
reason, and rest will usually fatten, but for 
the vast majority whose minds are only 
- disorientated, and who are free from any 
organic disease that could benefit by such 
measures, rest is absolutely the one thing to 
be avoided, the one condition, especially 
if combined with isolation, that may be 
relied on to seriously aggravate their state. 
For those whose only occupation in life is 
the so-called pursuit of pleasure, who ignore 
that pleasure depends little on externals, 
and is in any case restricted to narrow limits 
of capacity in man, and that games, hobbies 
and foreign travel are but poor substitutes 
for regular work, for such the outlook in 
Neurasthenia is a serious one. 

Truisms indeed, but how often forgotten! 

Fifthly, seek out the ambition latent 
in all of us. The patient at his first inter- 
view will give the clue, and it is for the doctor 
to make of it a lever. But “a stout heart 
for a stiff brae,’’ and the patient must creep 

5 


66 MINDS IN DISTRESS 


to the goal of his special desire if he cannot 
run; he must at once get a move on in any 
case. Most of us know by experience how 
small the prize when it is won, but we all 
remember how useful was the spur of hope 
that kept us to the way. More neglected 
truisms! 

Sixthly. Under this heading we may 
place all other agents. Of these Hypnotism 
is but suggestion “ writ large,’ and on sug- 
gestion in some form reliance must be placed 
throughout all the treatment of Neuras- 
thenia. In my experience it is rarely 
wise or even useful to place the patient 
under full hypnotic influence ; suggestions 
implanted in the trance state never long 
survive the awakening, for their impression 
is not on the conscious mind. They are like 
branches carelessly tied, not grafted, to a 
tree trunk and they early wither. Marvel- 
lous results were ascribed to Hypnotism by 
Dr Charcot in the old days at La Salpétriére, 
but the disease was Hysteria, and the innate 
tendency of the Hysteric to take a leading 
part in any function was forgotten, and, as 
recognized later on when the patients overdid 
the game, the doctors were either the victims 





NEURASTHENIA 67 


of deception, or failed, as I think, to fully 
interpret the phenomena. 

Food as an agent may be of great utility, 
especially where the original disturbing im- 
pressions are located in some one of the 
digestive organs. In them the results of a 
reduced dietary are most gratifying. My 
rule, in such cases, is to reduce nourishment 
to the point at which the weight, if a fairly 
normal one, can just be maintained. Ifthe 
patient be obese, weight should be taken off 
by a graduated dietary, plus exercises; the 
latter never to be omitted from the plan. 
For the Neurasthenic in good physical con- 
dition, and over thirty years of age, two 
meals a day—a good breakfast and a good 
late dinner—usually suffice. For the first 
fortnight a few sandwiches or biscuits and a 
cup of black coffee may be allowed at mid- 
day. If there be present active dyspeptic 
symptoms, half a pint of very hot and weak 
China tea (boiling water poured on a closed 
infusing-spoon till a pale shade of the fluid 
is produced, when the spoon is withdrawn) 
with a slice of lemon may advantageously 
be ordered at Ir a.m. and 5p.m. It is as 
efficient as, and much more agreeable than, 


68 MINDS IN DISTRESS 


the plain hot water usually advised. Maté 


may be substituted for the China tea. 
Indian teas, unless very fine, are not 
good, and milk and sugar as additions 
are anathema to all real tea-lovers. 

Yet, since you-should never—oppose a 
Neurasthenic\if you can honestly meet him, 
and as many are shocked at the idea of but 
two simple meals a day, so often have they 
been assured of the benefits of “ feeding 
up,’ you must now and then have re- 
course to a diet fad, and when you have to 
reduce the amount of food Vegetarianism 
is the best system to select. There is no 
food system that can be good—or even 
safe—for every one and everywhere, and I 
do not promiscuously advise Vegetarianism, 
but in suitable cases I must confess that I 
have seen great and durable benefit from its 
adoption, not only in nervous disorders but 
in gout, dyspepsia, rheumatism and many 
other diseases. Its effect, when beneficial, 
is chiefly due in my opinion to simple all- 
round reduction in the amount of food 
assimilated, for chemical analysis abund- 
antly proves that, until the digestive organs 
can accommodate themselves to the altered 





NEURASTHENIA 69 


circumstances, much of the vegetable 
material eaten (satisfactory as seems the 
chemistry of its elements on paper) is 
thrown off by the bowel. Incidentally this 
makes for regularity of evacuation. Like 
all other reduced food systems it tends to 
lessen the desire for alcohol and the craving 
for tobacco, and a few glasses of good light 


wine and half a dozen cigarettes a day should | 
be the limit in Neurasthenia. No novel” 
food system, least of all the ones that restrict 
their votaries to fruits or to meat, should 
ever be undertaken unless some instructed 
and responsible person be taken as judge 
of its effects, for all abstinence and fasting 
so clear the mind, and the result is so cheer- 
ing and delightful, that actual damage to 
bodily health may easily ensue ere the 
patient be aware of his danger. Tuber-~ 
culosis is a special risk in this connection. | 
Persons who speak of drugs as if they be- 
longed to some special order in nature, 
marked off by definite lines from foods, are 
misinformed. No such water-tight com- 
partments are known to chemistry; neither 
is there any standard of health by relation 
to which substances can be classed as good 


70 MINDS IN DISTRESS 


or bad. That only is beneficial which ade- 
quately supplies a need in the particular 
person. Even such things as common salt, 
oxygen or ozone, are deadly poisons when 
used in excess. Thus drugs whose full 
action is known have their use in certain 
eventualities, if not employed merely to 
mask a symptom at the expense of possible 
subsequent mischief. 

Mental exercises are during the course of 
an attack very useful, but they should, as 
formal exercises, be stopped directly the 
patient has got over his attack, for our minds 
are so constituted that strict affirmations 
readily call up a negative picture. I wel- 
come the recent rise in London of a school 
of mental exercise and mind culture, for the 
benefits to be expected of wise schooling in 
concentration and regulation of thought are 
of incalculable value to the community in 
general, and to business and professional 
men in particular; even the general physical 
health may be improved thereby. 

The mental exercises of use in Neuras- 
thenia are of a very simple order and should 
consist in a series of practical resolutions, 
said out loud, with the mind concentrated 





NEURASTHENIA a1 


on the thoughts, each morning when at 
rest. Thus, “I will get up at 8 am., I 
will breakfast at 9,” and so on with the 
simple duties of the day, and a quarter of an 
hour should be devoted, in quietude, each 
evening to a review of the result attained. 
Space prevents me from giving more than 
an outline of a system that, simple as it is, 
if faithfully carried out, is productive of 
much good. Life is thereby regularized 
and habit soon makes such regularity easy 
and natural. 

Finally, there is one most important point. 
It is always foolish for anyone to make 
health a subject of concern, for discussions 
about disease may by suggestion produce 
actual disorder. In Neurasthenia it is 
specially pernicious, and the patient must 
be put on his honour not to consult doctors, 
to read medical books, suggestive advertise- 
ments, or even articles on health in the press, 
and he must learn to check, and expel 
resolutely from his mind, any doubts, or even 
any thoughts, about his own health. The 
physician must lend his aid in the same 
direction, and, unless under special circum- 
stances, should not see the patient after his 


-3 MINDS IN DISTRESS 


written opinion with full directions has been 
given for at least six weeks or longer, and 
then only on condition that the simple 
measures advised shall have all been fairly 
observed. Any difficulty that may arise 
in the interval is best dealt with by letter. 
The one aim of all treatment should be to 
make the patient independent of the doctor, 
and no cure is worthy the name that does 
not secure this end. 

‘ Sexual Neurasthenia.—The matter is so 
important, and in some of its aspects so mis- 
understood, and moreover sexual Neuras- 
thenia itself gives such a perfect example 
of the origin and growth of all Neurasthenic 
states, that I need little excuse for making 
brief reference to the subject. 

We all know that boys at the impression- 
able age at which they attend school are 
apt to be mentally contaminated by evil 
companionship; the boy himself being un- 
aware of the consequences that will ensue 
later on when he wakes to the full conscious- 
ness of life—at from twenty to twenty-six 
years of age. At that age, under the strain 
of indoor work and of the natural perturba- 
tions that attend on the development of a 





itil iii ee atl al i 


— = = 


NEURASTHENIA 73 


function in its meaning more racial than 
individual, he becomes listless and self- - 
centred, and in that state may incidentally 
drop across some quack advertisement or 
some specious book that, under the benign 
guise of giving advice to young men, hides 
the most damnable attempts on his health 
and purse. Insanity, brain softening, con- 
sumption, fits, and especially a failure or Joss 
of virility are, according to the writers, but 
a few of the dire consequences of certain bad 
habits. All lies! for the habits referred to, 
objectionable as they are, have no power to 
produce any of these consequences, and 
beyond abasing the youth unduly in his 
own estimation, and at the worst producing 
a transient and easily-curable local hyper- 
sensitiveness and some functional disturb- 
ance of the sympathetic nervous system, 
do no harm whatever. 

But sexual Neurasthenia has been started, 
and though any experienced doctor could 
readily prove to the sufferer that neither 
physical disease nor insanity are even 
possible consequences of his acts, yet the 
impeachment of his virility makes a bogy 
hard to overcome. Any practical test is 


74 MINDS IN DISTRESS 


out of the question, and if tried would, by 
reason of the nervous doubts implanted, 
probably fail, and thus confirm the prognosis 
of the quack and establish the bogy more 
firmly in hisseat. Nor is it easy to reassure 
the patient, even when his local symptoms 
have been cured, to his entire satisfaction. 
Rigid censorship must, of course, be estab- 
lished over evil thoughts, a regime which, 
hard at first, is found, if persevered in, to 
be attainable; while everything that may 
prove suggestive must be taboo. These 
measures may re-establish the sufferer in his 
own estimation, but the question of loss of 
virility will often remain behind to rankle 
in the breast, and break out anew into 
a blaze of fear if and when marriage is 
contemplated. The mind of the sufferer, 
long the seat of sensuality, takes quite an 
erroneous view of the aims and duties of 
matrimony, and, being unable to realize the 
picture of a pure and simple love, free of even - 
the knowledge or thought of evil, still less of 
desire, pictures the future bride as a sensual 
ogress to be appeased. In many cases the 
neurasthenic man, knowing little of woman’s 
instinctive nature, has not even the wisdom 





NEURASTHENIA 75 


to keep his fears to himself, and the wife be- 
comes distressed by her husband’s nervous- 
ness, the foundation of which she cannot 
fathom. Fortunately, in the worst cases, 
those that do not get well of themselves, a 
doctor, by his knowledge of the innate 
negativism of Neurasthenia, and by appli- 
cation thereof in merely forbidding any 
attempt for a month and by taking the 
wife into his confidence, can secure a satis- 
factory result. In justice I should add 
that the foregoing condition of matters 
may arise in any neurotic man and with- 
out any antecedent evil practices at all. 

If the doctor knows of the bogy in 
advance he may forestall its evil machi- 
nations as the following case will show. 

A gentleman in perfect physical health 
but in a very neurasthenic state consulted 
me. It was many years ago and I had not 
learnt then what I now know. He sug- 
gested for six weeks prior to his marriage a 
daily subcutaneous injection of strychnine 
as a tonic, and I fell in with his views. All 
seemed to go well till a few hours before the 
ceremony, when he came to me in a state of 
such extreme nervousness that I feared he 


76 MINDS IN DISTRESS 


would never face the marriage at all. At 
my wits’ end I said, “‘ Well, in any case you 
had better have the last injection.” He 
consented, with supreme indifference and 
in profound gloom. My last tabloid of 
strychnine was gone, and, doubting the 
wisdom of informing him of the fact lest 
thereby I should increase his fears, I dis- 
solved a tabloid of 5th grain of morphia and 
injected it. The dose was, I knew, too 
small to do any harm, but I had no fore- 
knowledge of the actual result. He came 
in boisterously to see me some weeks later 
and remarked, ‘I don’t know what you 
gave me but I would have married forty 
women that morning if necessary.” 

Then it dawned on me that a sedative 
was what he had all along wanted; not an 
excitant such as strychnine. The morphia 
simply allayed all doubts, and, as he was 
quite unaccustomed to the drug, the effect 
lasted for two or three days. 

Such is sexual Neurasthenia, the most 
typical and amenable to cure of all the 
varieties if once it be treated reasonably, 
but it must be remembered that every local 
functional disorder must be always put to 





RS wes 


NEURASTHENIA 77 


rights before the mental state will yield to 
any treatment. 

General Considerations in the Treatment of 
all Cases of Neurasthenia.—Complete sym- 
pathy and understanding between doctor 
and patient must exist in any successful 
treatment of Neurasthenia. In fact, the 
doctor must be the confidant and trusted 
friend of the sufferer, and, by his accu- 
rate memory of details and his readiness 
to respond by letter to any query, prove 
that he is keeping the patient and his 
difficulties ever before his mind’s eye. A 
mental state in the patient must be met by 
the exercise of mental faculties on the side 
of the adviser. Frequent interviews, as I 
have elsewhere said, are never advisable, 
and as a practical physician I have often 
recognized the evil effect, in all sickness, of 
unnecessary visits and their bad influence 
in leading a doctor, at the call of some in- 
sistent but unimportant symptom, to depart 
from that strict line of treatment which a 
first careful examination of the patient has 
determined as the path towards cure. In 
Neurasthenia the patient is abnormally 
observant and critical in his study of the 


78 MINDS IN DISTRESS 


physician’s character and knowledge, and 
brusqueness, so often adopted as the cloak 
of ignorance, will raise opposition, ridicule 
and contempt in the patient’s mind; 
while the “ Cheer up, old fellow” attitude 
must be justly condemned as foolish. In 
Neurasthenia it is definitely the first step 
that counts, and if it be a false one the 
patient may be landed on the slope of 
a terrible descent. We have all met 
chronic and now hopeless cases of this 
disease in which honest but faulty methods 
adopted in the early treatment have been 
responsible for the final disaster. I could 
name several now living who still hug the 
bogy of a paralysis that has never materi- 
alized, and who, like the nervous lady look- 
ing under the bed for the burglar, daily 
search for signs of its coming, and, incredible 
as it may sound, one of them was urged to 
give up a prosperous, active life and devote 
himself to “‘a garden in the suburbs,” be- 
cause one day, for some unaccountable 
reason, he felt a dread in passing a certain 
house; another, a prosperous dentist, be- 
cause several times he had felt anxious about 
his breathing if more than three people 





eee 


NEURASTHENIA 79 


were together in a room; while a third, 
formerly an active city merchant, was 
condemned because he developed, by way 
of bogy, an unreasonable fear of bank- 
ruptcy and the workhouse; all specimens, 
as every Neurasthenic knows, of the most 
ordinary obsessions, which would have 
passed away in the active work of life, but 
were now rooted and nourished by constant 
self-analysis in the only occupation, ‘‘ com- 
plete rest,’ advised by some indifferent or 
thoughtless doctor who suggested insanity 
as the probable consequence of perseverance 
inwork. Now thatitis too late these people 
are miserably sane, occupied only with self- 
study and the discussion of fancied griev- 
ances ; for let us remember that to the active 
mind rest is impossible, and that, in default 
of larger interests with which to concern 
itself, it will turn over and over—magni- 
fying im the process—the most trivial 
concerns of a small household. Even the 
comparative mercies of insanity, with the 
oblivion of its fixed but false balance, is 
denied to these poor sufferers. 

I admit, of course, that there are rare 
instances in which, for very special reasons, 


80 MINDS IN DISTRESS 


rest may legitimately be advised in the early 
stages of Neurasthenia, and I know that 
certain organic brain diseases, in their be- 
ginnings, may present symptoms that can 
sometimes be mistaken for functional mental 
disorder, z.e., for a mere loss of balance. As 
a young man I made such mistakes myself 
and have seen others make them, but the 
early symptoms of such organic diseases 
as general paralysis of the insane and ~ 
disseminated cerebro-spinal sclerosis, very, 
very, rarely take the form of Neurasthenia, 

for the loss of balance which they simulate 

is that which is characteristic of the wider 
disturbance seen in the disordered feminine 
mind; namely, Hysteria. 





CHAPTER VI 
HYSTERIA 


t.é., loss of balance in the feminine type of mind 
Part I.—A Stupy oF THE FEMININE TYPE oF MIND 


F Neurasthenia be an inappropriate word 

to denote disequilibration in the masculine 
type of mind, what shall we say of Hysteria 
as adapted to the same phenomenon in the 
feminine one, for its very derivation denotes 
womb disorder pure and simple, though men 
of the Latin race are frequently the sufferers 
from an advanced form of it, and it is by no 
means uncommon, though usually in a milder 
variety, among males in the United States 
and in Great Britain. But we have practi- 
cally no choice of names for the vast symp- 
tom-complex with which we have to deal is 
known all the world over only as Hysteria. 

I gave in my third chapter a brief sketch 
of the feminine type of mind. Volumes 
would be required to do full justice to it, 


and behind these volumes would have to 
6 81 


82 MINDS IN DISTRESS 


be a mind of wide comprehension and great 
impartiality, stored with a varied experience 
of the most intimate sides of humanity. 
Therefore, if my description falls short, I 
fail in large company and because of my 
necessary limitations. 

That mind is in a sense represented in 
the brain there can be no doubt. How it 
is represented, what is the relationship be- 
tween the two, no one can say, though there 
is scarcely a philosopher that has not con- 
sidered himself within touch of the answer, 
and the physiologist of my younger days 
felt sure that he possessed a simple and 
complete one. A clearer day has dawned 
and the modern man of science confesses 
that he can but state, to quote almost his 
identical words, that in some way mind 
makes matter, and that, from what to us is 
the void, a function calls for an organ and 
the necessary organ, adapted to the desir- 


able function, is made: that physiology ~ 


makes anatomy and not vice versa. It is 
the old “ Fiat Lux” coming into its own 
again. 

But these altitudes concern us little; 
what we have to understand is that accord- 





- 4 A) = 


HYSTERIA 83 


ing to accurate observations certain portions 
of the brain act as transmitters of certain 
functions of the mind, that in general the 
cortex or upper segment of the cerebral 
hemispheres acts thus with regard to the 
reasoning faculties and the lower segment 
with what is called the subconscious or 
subliminal mind; not that we need attach 
any special value in this connection to the 
word reason, nor underrate the subcon- 
scious position of the mind because its 
pred-a-terre is the lower brain segment, for 
it is the seat of the emotions, of the wonder- 
ful and incomprehensible instincts and of 
genius. 

The feminine type of mind occupies a 
much greater area of the brain than does 
the masculine, and presumably that is the 
explanation of its wider range, its greater 
capacity and its relative incomprehensi- 
bility ; -but it has the defects of its qualities, 
and in that lies its weakness. More rarely 
do we find a perfect feminine type, and far 
more often, because its complexity implies 
greater tendency to instability, do we find 
complete freedom from some disturbance; 
for it is a rule throughout nature that the 


84 MINDS IN DISTRESS 


greater the complexity the greater the in- 
stability, the tendency on slightly adverse 
conditions to larger disturbance, and thus it 
happens that the feminine type of mind, 
though higher in facility and more extensive 
in its powers than the masculine, is but 
rarely seen in perfection; that imperfect 
types are the rule, and the imperfections 
more glaring to view and more numerous 
and more disastrous in effect than such as 
follow on imperfect forms of the masculine 
type. It is easy to sum up all the possible 
disabilities and failures of the latter; those 
of the former are as numerous as are its 
varieties of normal function. No region of 
the body, and not one of its functions, is 
safe from perversion when the feminine mind 
loses its hold over balance; not even what 
are known as the automatic and reflex 
powers are safe from interference. Per- 
mutations and combinations, to use a mathe- 
matical term, are then the rule of the day. 

I do not propose to treat you to a com- 
pendium of the many strange efforts that 
have been made to define Hysteria, some 
of them extravagant and all conflicting. 
What is to be said of the unconscious 


7 


Sr &® iv 


CHESTN: 


HYSTERIA 85 


humorist who, defining woman as an 
“organism revolving around a womb,” 
proceeds gravely to show how the orbit 
may be disturbed by pathological uterine 
states; or of his colleagues who assert that 
the functions of the womb are “ strictly 
mechanical,” and that it is certain outlying 
nerve centres that are answerable, by radia- 
tion, for all evil consequences; or of the 
grave physician who thinks he has really 
solved the whole problem when he calls 
Hysteria “‘an explosion,’ but deigns to 
add, out of charity for weaklings or pos- 
sibly scoffers, ‘‘ Nature having no outlet for 
superfluous energies, the whole system be- 
comes disordered ”’ ; or again, of the Viennese 
professor who finds the solution in the 
“sundering of consciousness,” as if ideas 
were tied like faggots into bundles; or of 
the American professor who sagely re- 
marks, “‘ Hysteria is essentially a psychosis 
as distinguished from Neurasthenia, which 
is a neurosis,” precisely, just as the world is 
not a spinning globe but a globe that is 
spinning. In one matter they all agree, 
namely, in an equal anxiety about the 
pathology. Now pathology is a resultant, 


— 


86 MINDS IN DISTRESS 


a physical change, not the process that 
instigated it. It is asif the pilot, neglecting 
navigation and the law of storms, and refus- 
ing to apply his mind to anything but to 
defects, spent his time exclusively in 
examining his craft for signs of damage 
and refused to take any measures of pre- 
caution in times of danger till he had dis- 
covered them, and ascribed some crowning 
disaster solely to the started planks or the 
rusty bolts previously found, or, failing such, 
adopted the theory of an explosion. 

One of the medical philosophers, however, 
puts his finger on a very sore place. When 
speaking of the so-called ‘“‘neuromimesis”’ 
in Hysteria, he very pertinently asks: “ How 
can memory set up a disease it has never 
seen? The disease (Hysteria) must be in 
psychic centres, but unconsciously; possibly 
a disease of cesthesodic cells of the cerebral 
hemispheres.” The least critical of readers 


will rub his eyes. Memory of course is out — 


of the question and must be dismissed, with 
costs against the writer, from the suit; as 
for disease being existent in a psychic 
centre, disease a post hoc existing as an 
ante hoc and in a psychic centre, 7.¢., in an 


. 


HYSTERIA 87 


abstraction! I give the quotation as a use- 
ful and very bad example of the false coin 
that finds currency in some circles. There 
is no real mystery at all, and the answer is 
extremely simple. Hysteria, being a loss 
of balance in the feminine type of mind, 
is a disorder of the whole brain, of the 
whole mind, and will therefore involve 
any or every function and throw any or. 
every organ of the body upon the de- 
fensive; for functional disorder (the only 
kind in which Hysteria develops itself) is, 
as translated by its symptoms, but the 
natural effort made by any organ, for the 
sake of the maintenance of the general bodily 
equilibrium of health, to keep itself to the 
point of due co-operation with all other 
organs. That is why we may have any 
and every functional disorder in Hysteria. 
The difficulties of the medical casuists are 
easily solved if studied on the ordinary 
principles of science and if we free our- 
selves from the tyranny of theory-begging 
words. It brings to mind the nursery 
couplet— 


“QO what a tangled web we weave 
When first we practise to deceive ”— 


88 MINDS IN DISTRESS 


but without, of course, ascribing to anyone 
voluntary deception. Real science concerns 
herself with simplification, not with com- 
plication, and in keeping to simple lines we 
shall save ourselves many a self-deception. 
Disorder and disturbance in any and every 
function of the body is what we then reason- 
ably expect, and what we get, in every case 
of Hysteria, while as to the form and kind 
it will assume that will depend upon the 
individual patient’s special bent of mind and 
upon surrounding circumstances: it may be 
blindness, deafness or muteness; loss of the 
power to move by will any one or more of 
the voluntary muscles and thus take the 
shape of a motor paralysis; or, leaving 
movement unimpaired, we may have the 
symptoms of a sensory paralysis, loss of the 
sense of touch, of temperature, of weight or 
of pain confined to a limb or a portion of a 
limb, or scattered promiscuously over the 
whole body; or we may have spasmodic 
contractions or absolute rigidities, dis- 
colorations or blanching of the skin, wasting 
due to local nutritional interferences, con- 
vulsions that may be quite partial, unilateral 
or general; or perversions of function may 





HYSTERIA 89 


be a prominent feature and the secretions of 
various organs may be altered in different 
Ways; or, again, the will-power may ex- 
tend its accustomed sway and obtain 
partial control over the usually automatic 
and reflex powers; or, strangest of all, 
psychic phenomena of a marvellous order 
may develop, in which the mind may seem 
to project itself, to partially disengage itself 
from its physical basis in the brain, as we 
see in certain spiritualistic performances, 
the best mediums for which are those that 
are endowed with a feminine type of mind, 
whatever their sex. That the absence of 
light is an essential to success in these 
demonstrations does not, in itself, prove 
them to be the result of imposture, conscious 
or unconscious, for it is possible that light 
may have some definite and intimate re- 
lationship to mind. While many of the 
demonstrations I have seen have been be- 
yond my powers of explanation, I have 
witnessed none that I could assert were 
decisively superhuman or due to agencies 
other than of the human order, while the 
constant and irritating intermixture of 
most phenomena with imposture—pro- 


90 MINDS IN DISTRESS 


bably not wilful in many cases—tends to 
confirm the candid observer in his views as 
to their dependence on subconscious human 
agency, for were it otherwise the question ‘4 
would arise: Why spoil a genuine and 
wonderful manifestation of psychic power 
by imposture unless you accept the theory ; 
that evil and lying infra-human spirits take 
a Puck-like part in the game, careless of the 

loss of credit involved in the adoption of 
such devices? 

As a strictly impartial critic I can only 
regard spiritualistic manifestations as ex- 
cellent examples of a _ feebly-developed 
feminine mind-type in a state of disorder, 
induced, as disorder in all of that type 
can easily be induced, by self-suggestion 
or by the suggestions of place, time and 
other minds. The audience, the dramatic 
setting and the suggestion are the three 
essentials in all hysterical as in all spiri- 
tualistic performances, and the reason of ~ 
this is to be found in a special develop- 
ment of the Ego, the self, which, as we 
found when dealing with Neurasthenia, is 
also the chief factor in the long series of 
trouble in that complaint. Why should 





HYSTERIA gt 


the mental isolation form of this exag- 
geration of the self be productive of so 
much mischief? It is a practical matter 
and sufficiently important to demand our 
notice. 

The Ego.—We know experimentally that 
in certain animal communities there is such 
a perfect unity of purpose as regards the 
well-being of the society and the perpetua- 
tion of the race that the life of the individual 
is if necessary sacrificed, without com- 
punction, to those ends. We may take the 
bees and ants as examples of such perfect 
communes, and, as is well known, you cannot 
long keep an isolated individual, separated 
from his society, alive and well, however 
favourable be the environment you may 
arrange. When itis a question of gregarious 
animals living in moderate-sized flocks and 
with a more restricted community sense, 
such as the parrots, starlings and other 
flock-forming birds, you may indeed rear 
a single individual if captured while young, 
but failure often ensues, and in any case, if 
the captive be liberated after even a short 
confinement, he is not again received into 
the flock. Even in animals, then, a certain 


92 MINDS IN DISTRESS 


‘ 


development of what I call the “ common 
mind’ is seen under most conditions of 
life in common, and the animal that would 
live a happy normal life, or indeed any life 
at all, has to subordinate his Ego to the 
general mind of his community, which 
latter acts in some of the most mate- 
rial affairs of life,, such, for instance, as 
migration in birds, and the formation of 
regular armies for attack, or even for a 
deliberate campaign, as in the ants, with 
one purpose as one mind. For this and 
other good reasons we may conclude that 
animals possess the same kind of mind, 
but of course much smaller in amount 
and more restricted in its range of ideas, 
as ourselves, and that therefore such of 
them as live habitually only in flocks and 
herds each possess a common mind (a 
share of the community mind), as well as 
a purely individual one. If isolation be 
then obviously in some way harmful to them 
we can readily understand that it will lead 
to far greater mischief in the human item 
of our modern communities, and indeed we 
actually witness among ourselves the same 
phenomena as in animals, namely the ex- 





HYSTERIA | 93 


pulsion from society of individuals that do 
not conform to its general spirit, such as 
criminals, tramps, beggars and loafers, who 
are often free from intentional and deliberate 
desire to be bad and often possess many ex- 
cellent individual qualities. These examples 
of this our human jetsam, as Lombroso and 
others who have closely studied them show, 
develop, after expulsion, a progressively 
anti-social spirit, becoming mentally more 
and more abnormal; though it is well to 
remark that in spite of their habits and 
unfavourable surroundings they do not in 
undue proportion become insane. Among 
the well-to-do and those fed and maintained 
by Christian charity an over-cultivation 
of the self leads to a similar perversion of 
the common mind (the latter then contain- 
ing in its elements too large a proportion of 
the Ego), and, unless this is checked by the 
freest association in work and active com- 
petition, it necessarily becomes more and 
more perverted until the Ego occupies the 
whole mind when mental isolation is com- 
plete and severe forms of Hysteria develop. 
It is true the public rarely come across such 
individuals, for they are kept sedulously 


94 MINDS IN DISTRESS 


from view by sensitive and kind friends 
and relations, and only doctors know from 
experience in what large numbers they 
exist. 

In the active masculine type of mind, 
a type limited almost strictly to conscious 
functions, this isolation is also keenly felt, 
and forms, as we saw in a previous chapter, 
its chief distress, and just because it is so 
keenly appreciated the fear of insanity is the 
commonest of the theories (bogies) based 
thereupon; but in the feminine type, with 
its far wider basis of consciousness, instinct 
and other powers, its relation to a far larger 
area of brain, consciousness plays a much less 
conspicuous part, and not only is no bogy 
formed, and upon it no salutary dread which 
may act as a drag on her downward path 
superadded, but the patient has little or 
no saving sense of isolation and even no 
knowledge of many of her actions. The 
hysteric cannot inhibit because one must, 
of course, be conscious of an impending 
action before one can take any seme to 
prevent it. 

Keeping then clearly in mind the normally 
wide range of the feminine mind-type, its 


is] 
» hen ee eed Pes 


HYSTERIA 95 


complexity and consequent tendency to 
instability, and knowing that it is subject, 
like the other type, to the same law of 
balance between its two parts (the individual 
and the common mind or common sense) 
for the maintenance of mental health and of 
mental comfort, we begin to understand how 
important it is that its possessor should above 
all things be brought up in surroundings 
that will secure the widest and freest human 
intercourse and contact with the outside 
world; that all the great principles of religion 
and morals which are fixed and serve as a 
final court of appeal within us should be 
early implanted and which, as founded on 
love, are readily absorbed by the feminine 
mind; that, in short, each and every of the 
faculties and instincts should be so de- 
veloped that the individual, at the period 
of his or her real entry into the society of 
the world, should possess a well-stocked 
and wholesome common sense (common 
mind) fitted to deal with every ordinary 
and likely impression and idea, 1.e., with 
every item of the individual portion of 
the mind that may be brought to its 
notice. 


96 MINDS IN DISTRESS 


Given a reasonably good heredity a 
feminine mind, thus wisely educated, will 
present to the world the very highest 
attainable type of mental development, 
a range of vision, a clearness of faith, a 
conception and love of ideals, a rapidity 
of perception, a breadth of judgment, a 
love and appreciation of the beautiful; all 
under the control of a reasoning power not 
slavishly tied to material possessions, never 
accepting the narrow and practical as the 
only view but beautifying by idealizing 
even the most carnal and sensual of our 
appetites. ‘‘ A little lower than the angels ”’ 
may this orderly type of the perfect feminine 
mind be styled; while, by way of contrast 
and comparison, it is hard to say more than 
“a little higher than the brute ’”’ of many of 
the pure specimens of the masculine mind, 
which, beyond some perfection of the 
mathematical faculty in its application to 
money, a certain regularity of action de- 
pendent on the same faculty, and a per- 
tinacity and fidelity which it shares un- 
equally with the bull-dog, has little or 
nothing to distinguish it from the higher 
animals, with which indeed, with much 





HYSTERIA 97 


persistence, it claims a distant relation- 
ship. 

Please remember the absence of any sex 
line. Most men who achieve renown and 
inspire affection and respect, and all men 
of fine character, brilliancy or genius, 
have, if not the perfect feminine type of 
mind, a large admixture of it, whilst the 
comparative absence of masculine charac- 
teristics in the great majority of women 
is often discounted in our admiration and 
respect by a conspicuous weakness in some 
of the best attributes that belong exclusively 
to the feminine mind-type, and as the fall is 
greater the consequences are more evident 
and more deplorable. 

And the great enemy to the formation of 
the perfect mind being in both types the 
Ego, and as woman by her very position in 
society, by the ingrained habit of centuries, 
by her surroundings, by suggestion ever 
ringing in her ears, and above all by her 
restriction to self-adornment in sexual com- 
petition, is by every artificial and natural 
means provoked to its magnification, it 
can be no matter for surprise if she thereby 
comes frequently to grief, 


98 MINDS IN DISTRESS 


But apart from her special environment 
there are in women other causes at work 
that gravely endanger her mental stability. 
The question of mental balance is simple 
in aman; he has, as arule, only his reasoning 
powers to bring into line with his individual 
propensities, but in the woman you have 
deep instincts firmly implanted in her 
that call for gratification. Take but the 
principal one, the maternity instinct, with 
all that it implies of unselfish love of 
the helpless, of a comfortable home of 
which she is mistress, of the companion- 
ship of, and reliance on, a mate. Here you 
have indeed a weight on one side of the 
balance, and if you cannot find the natural 
counterpoise, the gratification of the in- 
stinct, you will have indeed a hard task to 
find anything to put in place of it. The 
problem is complicated by the fact that 
being an instinct the possessor of it is un- 
conscious, or but half conscious, of its pos- 
session and influence and cannot therefore 
readily help herself. 

It would be easy to name other mental 
faculties, all instinctive in their character, 
that also frequently complicate the main- 





HYSTERIA 99 


tenance of balance in the feminine type of 
mind in both sexes. 

The problem of balance therefore in the 
feminine type of mind, and in those persons 
whose mental constitution contains a con- 
siderable admixture of it, is one that calls for 
the most careful thought. 

The great point is to understand it and 
in your calculations to adequately allow for 
it. Otherwise, you may very often be 
faced with a problem that seems insoluble, 
and may be tempted in a feeble manner to 
imitate the octopus in emptying your ink 
bag the better to conceal your discomfiture 
and retreat. 

The better to obtain a clear picture of the 
situation it will be instructive to devote a 
short space to the effects, in other depart- 
ments of life than medicine, of the mis- 
understandings and false situations that 
arise from the habit, dear to the masculine 
mind, of translating all phenomena, mental 
and physical, in terms of himself, and it 
must be remembered that this one-sided and 
false point of view is the outcome of the 
fact that, by reason of its concentration on 
the practical and material sides of life, the 


100 MINDS IN DISTRESS 


masculine type has obtained the control | 


of all the great political, legal and scientific 
systems and therefore holds at its sole 
discretion all the coercive powers, the mili- 
tary, naval and police, and most of the 
scientific, and a large share of the literary 
powers of the day. 

Its standards are therefore the usually- 
accepted standards in all civil and military 
concerns, and, though it cannot bring under 
its dominion the spiritual side of man, it is 
engaged in an incessant warfare with it. 
Selecting from religion only those maxims, 
such as justice and truth, and, with one 
eye on the voting booths, the material 
side of charity, which suit its purpose and 
act as pillars and foundations to its plan, 
it rejects the wider spiritual view of 
charity, the real and original and only 
strict meaning of the term, the love of God 
and in the second place of your neighbour 
because he is a creature of God, so perverts 
this virtue into a_ socio-politico-material 
monstrosity that takes form in the work- 
house, the relieving officer and the hospital, 
that truth, shrouding her keenest hits in 
proverbial form, has been provoked to the 





ae tal le A ee bt 





HYSTERIA IOI 


satirical expression ‘‘as cold as charity.” 
The pure masculine type of mind with its 
one talent, reason, but reason carefully 
restricted in definition to its purely mathe- 
matical side in argument and its material 
possessions and powers in evidence, puts an 
unrelenting heel on every opponent, on 
every advocate of wider, and presumably 
higher, conceptions, runs the world and 
throws a none too loving eye on the older 
universities that are rightly suspected of 
harbouring, in their theological and philo- 
sophical faculties, a spirit of wider range 
and establishing, as rivals to them, mere 
examining institutions, and, when these are 
discredited, modern universities in industrial 
centres, in which it fondly hopes that the 
material and the practical may hold almost 
undisputed sway. 

Because so much higher in constitution 
and so much more prone to disintegration, 
because so much more individual in 
character and so much weaker in combina- 
tion, the feminine mind-type, where mere 
counting of heads decides the day, can make 
but a poor fight, and while she pricks the 
thick hide of the enemy with her keen rapier 


102 MINDS IN DISTRESS 


of wit and satire, and holds him up to public 
ridicule by her subtlety of discernment, 
cannot secure the reins of power and there- 
fore prove her capacity to mend the rents 
and tears in the garment of society. Have 
we not at the present moment three excel- 
lent examples of this strife of mind-types 
in the political and religious arenas! The 
Celt in Ireland, and even after years of 
residence in other lands, loathed and de- 
spised the material system adopted by 
England in her desire to assist him, just as 
he loathed her materialistic religion with its 
soup-kitchens and other venal temptations 
in times of famine, and, not comprehending 
the type of masculine mind that honestly 
considers the material as the only valuable 
and real, suspected all her best and purest 
motives, exalting above England’s first 
statesmen the most gaseous degenerate of 
her own feminine type, provided he had 
wit and a certain speciousness; selecting 
often out of pure malice those which in her 
heart she least esteemed to represent her 
in Parliament so only that they might prove 
sharp thorns in the side of her enemy. But 
now that Irish self-government is within 


HYSTERIA 103 


sight the loudest threats are not heard from 
her feminine lips but from the masculine 
type resident in the North, who fear-— 
perhaps without real cause — an attack 
on their money-bags and possessions, and 
yet Home Rule, if secured for Ireland, 
will have been done so only by her re- 
presentatives having at length seen the 
wisdom of silence and of copying the 
ways and means of political success of 

Englishmen, typical of the purely mas- 
culine line of action: practical, practical, 
practical! ! 

And the Suffragist movement supplies an 
equally good and similar example. Like 
the Irish, the women in this country had a 
strong case in their demand that the feminine 
mind-type should be allowed some share in 

_ ruling the land they inhabited, and who shall 
justly grudge them some satisfaction of this 
claim when we remember how patiently they 
bore with the deprivation until the real dan- 
ger to them of an extended male franchise, 
with its influx of low-class masculine type in 
large numbers, arose. Then woman spoke, 
but, like the Celt, quickly perceived that 
mere protest would secure no rapid success 


1o4 MINDS IN DISTRESS 


and that her chance might be gone for many 
years if the male franchise were extended 
ere she secured the vote. Then she made 
the same mistake as the Celt. Instead of 
proceeding in the way that alone carries 
weight with the masculine mind, by silent 
combination and by strictly - reasoned 
speeches, she bubbled over and lost control 
of her more degenerate or less-balanced 
colleagues, always, as I have said, a large 
class in the feminine type, and emotion in its 
wilder forms and action of the most dis- 
orderly character, precisely as in the Irish 
situation, assumed that prominence loved by - 
the hysterical, who cares nothing for its 
disastrous effect on a cause sustainable by 
many valid arguments and making a strong 
appeal to fair play, provided she is only 
well in the limelight. And the religious 
world furnishes us with a last parallel. 
Fifty years ago the Church of England was 
sunk in a lazy indifference, when her sleep 
was broken in upon by that truly feminine 
spirit, the ritualist movement, which taunted 
her with her betrayal of the real Christian 
spirit, parading before her indignant eyes 
some of the beautiful symbolic ceremony of 


HYSTERIA 105 


pre-Reformation days, reminding her in- 
sistently that her rubrics claimed continuity 
with the early and medizval Church full of 
spirituality and self-denial, and lastly— 
worst cut of all—demonstrated, by the 
example of high-minded, self-sacrificing and 
devoted men, that higher ideals were still, 
as ever, capable of reaching and influencing 
for good the most hopeless and heart-broken 
of the human dust heap, and that poverty, 
humility and charity were more ennobling 
to the character than respectability and 
material possessions though located in the 
seats of the mighty. Even the Bashi- 
Bazouks of the campaign, who, as in the 
Irish and Suffragist movements, were of 
course early on the scene and did much to 
embarrass it by their hysterical antics and 
their unrestrained language, could not arrest 
its current, which has now attained such 
_ volume.as to sweep nearly all that represents 
the old masculine type of mind in the Church 
of England away. And the result has not 
been what was confidently predicted of it, 
a splitting up of the Church, but rather a re- 
welding together of an old fabric that was 
tending by neglect to fall into ruin, a 


106 MINDS IN DISTRESS 


rebreathing of a better spirit into dry 
bones. 

Personally I may be allowed to explain 
that I am by conviction a strong anti in 
regard to the questions of Home Rule, Female 
Suffrage and Anglicanism in any shape, but 
this does not hinder me from fairly stating 
the pro-case as I conceive it, conscious as 
I am that the Almighty Dollar and the mere 
gratification of our senses, our present chief 
standards of success, are unworthy and base, 
and hoping that, by a fresh infusion of mind, 
our ideals may be elevated and a wider and 
a better outlook secured for humanity; and 
we may be fortified in the face of possible 
fears by what science and philosophy tell 
us, that all the phenomena of life and 
nature are but the pieces of a puzzle partly 
broken up and rearranged by successive 
generations as new facts are discovered 
and wider combinations attained, and 
that each reconstructed puzzle is con- 
fidently viewed as the one real and final 
solution. 

I have endeavoured to give in a pictorial 
way an idea of the feminine mind-type, 
and if only the reader can gather from my 





HYSTERIA 107 


description of its many and elusive elements 
a fair general conception of its whole he will 
find the study of its derangements, which 
has puzzled many, quite easy to follow and 
to comprehend. 


CHAPTER VII 
HYSTERIA 


z.c., the loss of balance in the feminine type of mind 


Part II].—TuE SYMPTOMS AND TREATMENT OF 
HYSTERIA 


Special predisposing influences in the production of 
Hysteria 
HESE may all be grouped under two 
headings, which for simplicity I will 
call the exalted Ego, meaning thereby all 
that tends to over-cultivation of self, and 
the starved instinct, which includes all 
checks to the proper gratification of normal 
instincts, for such are the two great under- 
lying causes of every hysterical development. 

We must, however, also make allowance 
for three different types of feminine mind 
commonly met with, which we may thus 
classify: 

(1) The pure feninine mind-type. Though 
occasionally men, and very charming ones, 
fall, under this heading, it contains, as we 
should expect, a high percentage of women, 


and may therefore be spoken of in the femi- 
108 





HYSTERIA 109 


nine gender. Femininity is apparent in all 
her works and ways; she is a real “‘ female 
woman ”’ ever and everywhere. 

(2) The weak feminine mind-type, a pro- 
duct often of unstable mental heredity, in 
which the balance is visibly unsteady. 
Many men belong to this class. 

(3) The med type, having many pro- 
perties of the masculine mind. The ordi- 
nary Englishwoman and the business French 
and Belgian woman may be regarded as 
fair examples of it. 

Now each one of these three classes will 
react very differently in similar circum- 
stance. The first will be stable in her very 
instability, exhibiting in ordinary life, by 
the active play of her emotions, the oscilla- 
tions of a sensitive balance tending to re- 
equilibration ; but under gross and prolonged 
mismanagement, or under some severe or 
sudden check to some one of her deep in- 
stincts, such as love, may be expected to 
exhibit the widest functional perversions, 
the most perfect example of the disorder in 
its fullest range, the Hysteria major or 
malignant Hysteria of the text - books, 
The second type, a very large one, weak from 





IIO MINDS IN DISTRESS 


the start, and reacting to the ordinary 
stimuli of life always abnormally ; essentially 
unstable during her whole life, excitable, 
weakly emotional, selfish, indolent, unless 
goaded to exertion by the lure of self- 
gratification; always ailing and sick because 
her various organs, for want of regularized 
nerve control, are ever at fault in their 
functional duties; receptive to any idea 
that can titivate her emotions, throwing 
herself literally into each new movement in 
which she sees a new mental stimulant; 
unable to be straightforward but exaggerat- 
ing and colouring her every statement, un- 
reliable and untruthful; of shallow intellect 
but often smart and quick by fits and starts, 
she forms the backbone of every anti-move- 
ment, of every fad, of every new system, and 
specially delights in those that have a trace 
of sexual piquancy. We are all familiar 
with the type, and most of all can re- 
cognize it at a glance by certain physical 
characteristics. It is from this type that 
the largest number of Hysterics arerecruited ; 
they do not often rise to great heights even 
in this disorder but are rarely for long free 
altogether from some taint of it. The 


HYSTERIA III 


third type comprises the great bulk of 
ordinary middle and lower-class English- 
women, slow in thought, safe from temp- 
tation because void of imagination, adopt- 
ing the current standards without concern 
for any great principles, unambitious and 
docile, good mothers, and generally pattern 
Wives, steady and, above all, reliable be- 
cause mentally the most stable of the three 
types. In this class may be ranged quite 
a considerable number of males who, under 
the stimulus of a wider life than that of 
women, exhibit often artistic taste and skill 
of a high order. It is the women belonging 
to this class who alone of their sex are fitted 
to battle with the world and compete with 
men in the duties of life that call for steady 
application to uninteresting and routine 
work, and unless under the sense of grave 
disappointment, or handicapped by the times 
of stress that belong specially to their sex, 
they rarely fall victims to any serious form 
of Hysteria. In all women the menstrual 
cycle tends somewhat to lower the standard 
of stability, though too much of this has 
been made as a factor, and indeed it is open 
to question whether its effect has not been 


112 MINDS IN DISTRESS 


increased by the attention paid to it by 
the medical profession and by the quite 
unnecessary precautions recommended at 
such times in the case of the average woman. 
The same applies to puberty and the 
climacteric. If women were left more alone 
in these matters, and only the real organic 
diseases treated when necessary by surgical 
procedure, as is the case with men, it is 
certain that, beyond those blights of frus- 
trated maternal function called fibroid 
tumours, and the disorders which follow 
on infections, that the law should do more to 
render impossible, a long list of disorders 
peculiar to women would disappear from 
the world. An immense improvement in 
this respect has taken place within my 
memory, but superstitions die hard and 
many a woman’s life is still wrecked by her 
attention being wrongly concentrated on 
the sexual apparatus, and the result is seen 
in the Nemesis that waits on self-concentra- 
tion—Hysteria. She does not become im- 
moral, but morbid. The most scathing con- 
demnation of such malpractice I have ever 
heard came from the lips of one of thegreatest 
medical experts in this special department 





HYSTERIA 113 


at the present day. Too much so-called 
sexual physiology as a subject of instruction 
for young girls is also to be strongly depre- 
cated as tending in the same direction, and 
one has only to read the advertisement 
columns, especially of some of the pseudo- 
religious prints of the day, tosee that there 
are, as we saw was the case in young men, 
plenty of vampires ready to magnify a 
function into a mystery and to batten on 
this special form of anxiety, though the 
Book which they expcund with so much 
unction wisely refers the sex to “the law 
of her mother and the covenant of her 
God”’ as the surest of guides. 

Hysteria: What it 1s and what it 1s not.— 
Emotion, even if it appear to the more 
phlegmatic to be in excess, is not Hysteria, 
for in many persons of both sexes who are 
perfectly stable, the natural outlet to the 
strain of adverse circumstances takes the 
form of tears, sobs, prolonged laughter, 
tremors and other muscular actions, flushing 
or great volubility. Nor under great pro- 
vocation should a convulsion, or even a 
succession of them, be thus branded but be 
read as a physiological effort to restore the 

8 


114 MINDS IN DISTRESS 


mental equilibrium on the natural lines of 
least resistance and proof only of a healthy 
tendency in a sensitive nature even if they 
occasionally pass beyond voluntary control ; 
for there is no fixed boundary in Nature 
between health and functional disorder, the 
first is physiology in normal circumstances, 
the second physiology in abnormal ones, and 
both have one common goal, the mainte- 
nance of life. But nevertheless we shall be 
safe in adopting as a general rule that all 
symptoms beyond our conscious and volun- 
tary self-control are those of disease and 
apply this rule to Hysteria. 

The Symptoms of Hysteria.—The feminine 
mind-type being in its fullest development 
co-relative with the whole brain, the signs 
and evidence of its disorder will be co- 
terminous with the body, each organ whereof 
is represented in some part of the brain by a 
centre of direction. The list of symptoms 
will be therefore necessarily a very extensive 
one, and, to prevent confusion, the best plan 
will be to consider in broad groups the main 
psychical functions and give instances of 
their perversions. 

The higher brain is of course an artificial 


HYSTERIA 115 


division, for we have no certain data on 
which to found any strict boundaries, but 
we may understand by the term that part 
of the brain that is en rapport with conscious 
thought. Perversions of consciousness are 
very common in Hysteria, and indeed it may 
be said that every case of real Hysteria 
involves some impairment of it, and the 
interesting and often-debated question there- 
fore presents itself: Are Hysterics fully re- 
sponsible for their thoughts and apparently 
voluntary actions? And the answer is: 
Control of them is always weak and often 
apparently wanting. The same is true 
of their memory regarding them. Then 
is not Hysteria a form of Insanity? The 
dividing line in bad cases is a fine one, but 
there is such a line, and if you carefully 
study a severe case you will find that the 
mental balance is never in Hysteria “ off 
the pivot,” as in Insanity, and that the oscil- 
lations, though so vigorous and rapid as 
scarcely to be followed by the observer, are 
nevertheless present and, though they lack 
rhythm and equality, are, as always, sure 
evidence that the jeopardized balance is still 
in working order. And one of the best 


116 MINDS IN DISTRESS 


proofs of this fact is that recovery may take 
place quite suddenly even in the most violent 
of attacks, a phenomenon never seen—or 
seen so very rarely as not to invalidate the 
rule—in Insanity. There therefore always re- 
mains in Hysteria some control power in the 
higher mind, some consciousness and some 
memory, however dim, and even in those 
cases in which the Psyche, as it is called, is 
split up, when each hemisphere of the brain 
appears to act independently of the other, 
and when the patient asserts that each half 
constitutes an entirely independent self, you 
will, on careful examination, find proof of 
it. I knew some twenty years ago a lady 
who while talking, reciting or playing could 
simultaneously write a good and original 
essay on any selected subject, and this with- 
out looking at the writing hand, which did 
its work equally well on a pad placed on or 
under the table at which this lady was seated. 
She said that the writing was beyond her 
control. Much of it was emotional and 
foolish, and parts distinctly obscene, showing 
that some of the lower instinctive mental 
faculties were at work. One manuscript 
was a false and lurid account of a parturition 





HYSTERIA 117 


(the lady was young, single and of blameless 
life), with illustrations of terrible hooked 
instruments with spear points; the whole 
production very realistic. When I sug- 
gested that circlets should be added to 
complete the picture, a series of large con- 
necting rings was automatically added. 
This patient also claimed the power to throw 
herself into a cataleptic state, and in that 
condition to be able to send her soul on 
errands of inquiry into the past and future. 
The result of any information thus obtained 
consisted only of vague generalities that 
might fit almost any case, or be adapted to 
it, no clearer details in the way of a test for 
truth being ever obtainable. One could 
not fail to remark how eagerly even intelli- 
gent members of the audience sought to 
adapt the predictions and statements to 
themselves or their friends, and how un- 
popular it was to be critical. This lady did 
not use her powers for purposes of making 
money and only for the kudos it brought 
her. 

I have also frequently witnessed in 
hysterical persons instances of pseudo- 
double personality, two very opposite 


118 MINDS IN DISTRESS 


voles in life being played in succession, 
but this was never the real dual person- 
ality of psychic forms of Epilepsy, for 
the patient could always be recalled to 
her former self promptly by some simple 
means. 

In cataleptic states the appearance of 
the patient may be so changed as to be 
scarcely recognizable. Generally there is 
great pallor, with large immovable pupils, a 
cadaveric rigidity of the facial muscles with 
slowing of the heart and the respirations; 
in fact, both the latter may appear to 
be on the point of cessation. All the 
vital functions seem lowered, and one 
can well understand how long periods 
of fasting with but slight diminution of 
weight are possible in these mental 
states. 

The results of these exhibitions on the 
patient herself are harmful, and the tendency 
to instability increases markedly by repeti- 
tion, so that at last a look, a word, or ten 
drops of Indian hemp in water, is sufficient 
to induce the scene. We cannot, however, 
linger over this very interesting subject, 
instances of which are of common occurrence 








HYSTERIA 119 


and objects of surprise to non-medical and 
wonder-seeking onlookers; yet even the 
most sympathetic of observers cannot help 
being often shocked by what must seem to 
be intentional deception so unwisely and 
unnecessarily added to phenomena re- 
markable enough in themselves and they 
naturally ask the question: “‘ Why this moral 
obliquity? May not the whole demonstra- 
tion have been carefully studied and re- 
hearsed with the sole view to deception? ”’ 
The correct answer is to be probably found 
in a study of the mental equation (see 
Chapter IX), and in the conscious resist- 
ance to some one of the moral faculties 
having fallen with a corresponding rise in 
others, and to view the matter thus pictori- 
ally will help us to visualize what other- 
wise could be expressed only in abstract 
terms. It gives us a percept instead of a 
concept. 

The middle brain, again a division not 
meant to be anatomical, the ped-a-terre 
of the subconscious or subliminal mind, 
the seat of the instincts and the habits, 
sometimes called the ‘“‘ acquired reflexes,”’ 
next concerns us, and a host of dis- 


120 MINDS IN DISTRESS 


orders of many shades is rendered pos- 
sible by its perversions from the normal. 
In comparison with the higher brain it is 
subject in health to fewer oscillations, for 
the impressions it directly receives are less 
in number. The sexual instinct, which in 
women is mainly maternal in hue, shows 
curious and sometimes revolting alterations, 
but of such a matter it suffices us to say that 
their direction is not towards open vice 
but to psychical exaltations of the sex in- 
stinct, with which certain practices are some- 
times combined, and in connection with 
which we may often acquit the victim of 
any knowledge of conscious wrong. The 
perverted maternity instinct is seen in an 
extreme devotion to animals, or even to 
inanimate objects, and in the various ways 
of “mothering,” in a weak, silly manner 
and productive of little good, the heathen, the 
drunkard, and especially the vicious who are 
its objects, often harming them and bring- 
ing ridicule upon otherwise lofty causes. 
Other instincts, such as the artistic, may 
undergo similar aberration with deteriora- 
tion or improvement in ability, and I have 
known a mere dauber become converted 





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epee See dete Pe A eS 


“¥ begs? 


an) nl ee 


HYSTERIA 121 


into a painter of considerable taste and merit 
when suffering from a severe general form of 
Hysteria. There is practically no limit to 
the strange phenomena that may be seen 
when this same subconscious mind is per- 
turbed. It may then throw to the surface 
words, expressions and conceptions that 
lay buried therein, or make its oscillations 
the basis—as I have explained in Chapter 
ViI—of endless mimicries of disease. The 
habits or acquired reflexes exhibit a like 
disorder and may be broken up, combined 
in fantastic fashion, or, for the time being, 
obliterated; the methodical man or woman 
may become careless of time and place,— 
night as the time of wakefulness and activity 
' may be substituted for day—and a confirmed 
smoker, or even opium-eater, may absolutely 
forget the existence of these narcotics. I 
have known instances of all. There is no 
_ hard-and-fast line in Hysteria as there are no 
real frontiers in the brain, and all sorts and 
varieties of disorder may be mingled to- 
gether in one single hysterical individual, 
the conscious mind, as I have said, being 
always one of the parties to it. Occasion- 
ally, however, what may look like isolated 


122 MINDS IN DISTRESS 


hysterical symptoms appear, and these are 
always the most puzzling to the physician. 
I can recall a highly-emotional man who 
had the “ gift of tongues.” If he met with 
opposition in any cherished design, or were 
influenced by suggestion in any form, he 
would forthwith deliver himself of a stream 
of gibberish which varied on each occasion 
and had a specious resemblance to language, 
by the emphasis and modulation given to 
parts of it. He would argue in it or preach 
in it. It contained many Latin and Greek 
words, and yet he professed an entire ignor- 
ance of both those tongues. He was not 
insane, and explained the process by saying 
that he felt an irresistible impulse to act 
as he did, but his flow of speech could 
always be arrested by loud laughter or 
ridicule from his audience, or by any 
sudden and, to him, impressive incident. 
Eventually he lost the “ gift,” but was 
left with an impulse to it, which he could 
restrain, whenever anything upset him 
gravely. He was always a copious shedder 
of tears on the least provocation, and 
equally on occasions of joy, sorrow or 
anger. 


HYSTERIA 123 


The lower brain and spinal cord and 
sympathetic centres, that are in psychic re- 
lationship with the function of organs and 
their secretions and excretions, with the 
control of the blood supply, the many 
functions of the skin, the rhythmic move- 
ments of the heart and lungs, and the peris- 
taltic movement of the intestines, make up 
our last grouping. Disturbances by excess 
or diminution may occur in any one or more 
of them, and may be restricted to them or 
accompanied by evidences of Hysteria in 
higher centres. Perhaps an example best 
appreciated by the laity is seen in the case 
of the liver. I knew an hysterical woman 
who in any opposition to her special form 
of self-esteem invariably developed jaundice, 
and not only was the output of bile into the 
bowel brought to a standstill but the actual 
amount secreted by the liver was much 
reduced. Another lady, who nourished 
herself on the sympathies that attach to 
invalidism, told me that her heart was so 
weak that the ascent of the smallest hill 
brought on palpitation and irregular action, 
and this was, as I found, an actual result. 
One day I took her after dark up a hill, the 


124 MINDS IN DISTRESS 


slope of which was obscured by the darkness 
and conversation, and her heart remained 
quite unaffected, but when told of the ruse 
next day it became at once so disordered 
that her friends requested me, for the sake 
of their own comfort, not again to try such 
an experiment. I have seen a sharp attack 
of spasmodic asthma follow immediately 
on a wound to the self-love. Great exaggera- 
tion of the muscular reflexes is a general 
accompaniment of Hysteria, but again they 
may be decreased almost to the point of 
extinction. Great dilatation of the pupils 
of the eye and failure of reflex response to 
light or distance are not unfrequently seen, 
and sometimes the pupils may become un- 
equal on the two sides or ovoid in shape. 
Perhaps the most astounding of phenomena 
is one that has been witnessed in more than 
one hospital; a reversal of direction in the 
peristaltic muscular action of the coats of 
the intestine, which in health gradually 
works food slowly through the coils of bowel 
towards the outlet; while reversal of this 
direction occurs only in complete stoppage 
and, when unrelieved, is accompanied by 
another and grave symptom, feecal vomiting. 





HYSTERIA 125 


But Hysteria has provided a parallel even 
to this. Not long ago in an East-end 
hospital there resided a patient who had on 
three previous occasions, by reason of these 
symptoms, undergone operations, nothing 
wrong being found in any of them, and she 
was prepared to again submit to a like pro- 
cedure; but her past history having come to 
life she was saved from the experience and 
recovered. Now it is hardly conceivable 
that any element of fraud could have been 
present in this case, nothing was to be gained 
by facing a grave surgical risk. But, on the 
other hand, and about the same time, but 
in another hospital, a woman, recognized 
as a victim to Hysteria in many shapes, 
had also fecal vomiting, but on careful 
observation she was discovered to be arti- 
ficially bringing about the process; yet even 
in this case, knowing the possible wide 
variations in the mental equation seen in 
Hysteria and the horrible procedure to which 
she had recourse, it may fairly be doubted 
whether the imposture was as consciously 
deliberate as it appears, for the moral 
sense is always blunted in Hysteria, and 
there is an absence of shame on exposure 


126 MINDS IN DISTRESS 


such as is never witnessed in similar people 
in health. Let me then ere we leave the 
question of Hysteria once more ask the 
reader to pause before he thoughtlessly 
ascribes Insanity or fraud to any hysteric 
case. However grave the symptom in 
Hysteria, it can be stopped at once by some 
sufficiently strong counter-emotion, and if 
either of the women with fecal vomiting 
had been told that a favourite child was 
lying at home in danger of death the vomit- 
ing would almost certainly have ceased and 
the patient forthwith have re-found the 
power of returning to her home; but re- 
member carefully it must be an abnormally 
strong counteracting emotion, whereas, in 
a normal state of mental health, sufficient 
inducement to recovery in emotional states 
would have been found in some common 
and everyday emotion ; while in Insanity no 
emotion, however powerful, would have any 
effect. The difference in the three situations 
is therefore a very real one and must be 
kept in mind. 

The foregoing is intended not as a detailed 
description of Hysteria in its protean shapes 
but more as an effort to provide a mental 





7 





c of the Ba siide so that the reader 
n and retain a clear view of the i 
L fot hs laws that underlie Hysteria © ie 
on the effects of which its symptoms cae 









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CHAPTER VIII 
HYSTERIA 


t.e., loss of balance in the feminine type of mind 
ParT III.—Tue TREATMENT OF HYSTERIA 


HE treatment of Hysteria is a battle 


but not on the solid earth, a combat of 


minds between patient and adviser, and the 
weapons of the latter are not those of the 
pharmacy nor of science, for these must be 
kept carefully in the background and re- 
served as mechanical aids after the real 
victory has been secured, as props and stays 
on the stony road that has to be travelled 
after the patient is on her feet and before 
she can walk with assurance on the broad 
highway of humanity. Therefore the first 
essential to success is to: 

(1) Understand and control the patient. 
Not only is it necessary to get on good terms 
with the patient—that is easily effected, for 
she will at first regard you as a probable 


ally, as one to become in the near future a 
128 


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Ca 
comer 4 


HYSTERIA 129 


follower in her train—the first look she 
throws at you under half-shut lids, and with 
eyes that affect to be tired and indifferent, 
is but the first stage in that ‘‘ summing 
up” of you which, translated into words, 
would often take some such form as this: 
“ Another ass that thinks he is going to 
control me; we shall see!’ But the doctor 
must not, in foolish self-assurance, despise 
the enemy, an attitude so often assumed and 
about which the patient is sure to be informed 
however far from the sick-room it may be 
expressed, whether in signs or words. Like 
a skilful gambler the doctor’s look must 
conceal his thoughts, and at the earliest 
opportunity, and after he has made himself 
master of all necessary details from friends, 
who rarely or never can give any useful clue 
to the mystery, he should dismiss the latter 
to have a heart-to-heart talk with the 
patient: Now, and just in proportion to 
his knowledge and skill, he will obtain real 
information. No real active organic disease 
will be found, for as in Neurasthenia so in 
Hysteria all the vagaries seen are but the 
oscillations of a healthy mind in a state of 
stress and blindly seeking a balance, and 


130 MINDS IN DISTRESS 





would vanish of their own accord in face of 
tangible disease. Some quiescent organic 
mischief, having no part in the production 
of the present symptoms, may be found, but 
even this is rare, while, almost invariably, 
some trivial displacement of a kidney or 
uterus, ovary or stomach, or some func- 
tional derangement, evidenced by headache, 
flatulency, etc., will be brought with great 
formality to the doctor’s notice, and he 
will be told—and not truthfully—that Dr — 
So-and-so considered it a most important 
disease, one that would take years to cure 
and which required the utmost care and 
attention if death itself, or chronic invalidity, 
were not to be the result. The wise man 
will not contradict, still less will he remark 
that such-and-such an organ could be 
stitched into position by surgical operation, 
for unlike the Neurasthenic, who has the 
practical mind and dreads operations, be- 


cause he fears the possible consequences, _ 


the Hysteric would promptly fall in with the 
suggestion and, even if the doctor failed to 
carry it out, he would find himself for ever 
quoted as an authority, and styled an expert 
or specialist, who strongly advised a serious 





HYSTERIA 131 


operation as the one and only cure, and 
who, but for the fact that she (the patient) 
was at death’s door at that time, would at 
once have performed it. For a marked 
characteristic of the hysterical mind is that 
it has pluck, if courage can be ascribed to 
one who lives mainly for the sympathies 
of the day and has little thought, or fear, 
of the morrow. The doctor’s next step is, 
under assurance of the strictest secrecy 
(which he must most honourably observe 
both in the spirit and in the letter), to obtain 
from the patient a real and complete mental 
history, showing by his intercalated observa- 
tions that he fully understands and can 
sympathize with all her grievances and 
contrarieties, and that he reckons none of 
them as trivial since they are of importance 
to her; the real test. If the doctor be him- 
self in the widest sense a man of under- 


_ standing he will rarely fail to get the whole 


truth, and the picture thus obtained will 
be very dissimilar to that which even the 
nearest and dearest of the patient’s friends 
would ever have dreamt of. He will hear 
of cherished desires frustrated, secret am- 
bitions balked, keen emotions and feelings 


132 MINDS IN DISTRESS 


chilled; in short, he will see that the 
patient has been musunderstood, no silly 
phrase but one representing the real and 
deep wound of a sensitive and often a really 
high and fine nature whose legitimate and 
normal Ego has been dwarfed, and her 
instincts starved or blighted. He will, 
further, be astonished to find that the 
patient, if she meets a kindred, or at least a 
comprehending, soul, can be truthful, and 


that her deceit and lack of truth previously ~ 


noted is but what she conceived as necessary 
to play the only véle left her in life—that of 
a debilitated and sympathy-craving invalid. 
“Tout comprendre est tout pardonner,” 
and in the doctor’s case one may often 
add “‘tout pouvoir.’’ How extraordinary is 
such a confession; what a totally different 
person and character you have presented to 
view, and if you shut your eyes the better to 
construct your mental picture you may be 


startled on again opening them at the con- - 


trast that presents itself. How little we 
really know of human life, and how far it is 
from the picture that casual and even in- 
timate observation often provides for us, 
though it would obviously never do to wear 





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HYSTERIA 133 


always one’s real mind or heart on one’s 
sleeve; and even if we did, it would only 
be our mind as viewed and appraised by 
itself. 

One cheering result I have gained from 
such disclosures is the conviction that there 
are few intentionally and maliciously bad 
people in the world, but there are a host of 
weak and feeble persons, and that very few 
of them have any compass that points to 
any definite magnetic north; conventions, 
bitterly hated by many a woman who out- 
wardly affects to worship them, there are in 
plenty, and some feeble principles, mere 
wisps of thought touched by a faint hope 
as by asun ray, and chiefly used as counters 
in the game ‘of life. Instincts deep and 
broad there are which, controlled and guided 
by the reason and allowed due gratification, 
could make life sane and tolerable, but to 
make it consistent, satisfying to the higher 
mind, and occasionally really happy, you 
must have much more: an unshakable con- 
-viction that there is an end in which the soul 
can rest withevery longing satisfied and every 
inequality of life made straight. Science 
cannot fill the gap; she starts with a nescio 


134 MINDS IN DISTRESS 


and ends of necessity with the same; her 
duty being confined to the reduction of 
phenomena to the order that best fits the 
Zeitgeist, the simplification of a problem 
not its solution, and the vdéle of philosophy 
is to co-ordinate her conclusions into wider 
generalizations. Both are of inestimable 
use as training-grounds for the mind, but 
neither makes any pretence of a final 
definition. 

To say more would be to exceed the limits 
of my subject and my remarks are merely 
the thoughts that must arise in all reflecting 
minds brought face to face with the pro- 
blems of life as set by the nude mind; and 
it is not for the doctor to do more than 
quietly regret this absence in the life of 
sufferers of any guiding star that would be 
of assistance to him in giving direction to 
his efforts. Indeed, not long ago a chronic 
Hysteric rose from her bed and interested 





herself again in life at the instigation of — 


Christian science, and a lady in the north of 
London, after years spent as an invalid 
with hysterical paralysis of both legs, was in 
a few minutes cured by a revivalist preacher 
who had taken up faith-healing. She heard 


HYSTERIA 135 


of his powers, was impressed, sent for him 
and was cured. These cases show the pro- 
found influence even of very third-rate 
ideals on minds not necessarily of small 
calibre but untrained in habits of clear 
thought, and I was most careful to offer no 
opposition in either case; a half loaf being 
not only better than no bread but the 
quantity often better suited to a feeble 
digestion. Astotheresult. It was durable 
in the first and not in the second patient, 
who could not be made to comprehend, 
when the pastor subsequently proved to be 
morally a friable vessel, that such fact had 
nothing whatever to do with herself, and 
that a leper may show you the right road 
though he has not the strength himself to 
~ walk along it. 

The question of all mental treatment is 
so important, and the subject so interesting, 
that a strong temptation to extend the 
theme arises in my mind, but I feel that 
sufficient has been said to give all that I can 
here pretend to supply; the direction in 
which treatment to be successful should 
be carried out, with the one objective before 
the mind, the restoration of the patient to 


136 MINDS IN DISTRESS 


normal life and activity. One fallacy— 
dear to the masculine mind and afforded a 
prominent place in many an official text- 
book—I wish to condemn, namely, that 
the deprivation of sexual congress is the 
great if not the only thorn in the flesh of the 
sufferer and the one which incessantly vexes 
and disturbs her spirit. In fact, more than 
one writer goes so far as to say that the 
thoughts connected therewith are to be 
screwed out of her by hypnotism, or other 
form of suggestion, and met by the installa- 
tion in her mind of negative ideas; and if 
these statements are disputed one is met 
by the remark, “‘Oh, you can’t deny the 
truth for the patient herself acknowledges 
it.”’ Quite so, it is precisely the idea that 
an Hysteric would concur in, just as she con- 
curred with Dr Charcot in his acceptance 
of the idea that disease could be transmitted 
by a magnet or even by a glass of water. 


“Fooling him to the top of his bent” is - 


precisely the game of games for her, why I 
know not, unless it be that she thereby ex- 
presses her contempt for the masculine type 
of mind and her insight into some of its 
inherent weaknesses. Marriage doubtless 


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4 HYSTERIA 137 


often cures a woman, but chiefly by respond- 
ing to the demand of her instincts for un- 
selfish love with its idea of self-immolation, 
but any want of response to affection will 
bring a relapse into Hysteria even after 
marriage. Maternity is the best cure of 
all. There are few women, outside the 
ranks of the degenerate and perverted, to 
whom crude sensuality alone is a potent 
appeal, though most women are quite willing 
that men should believe the contrary, and 
bad ones of every grade encourage the idea 
because their profit arises from this misunder- 
standing, while among intimates they laugh 
heartily at it all the time. That there is a 
vein of weak psychic immorality in many 
types of Hysteria one cannot help recog- 
nizing, but this is as a rule shrouded in noble 
sentiments that doubtless are regarded as its 
excuse or justification. As evidence that 
this disorder cannot usually have sensual 
gratification as its chief foundation, I may 
add that, for a series of years, I attended 
several communities of religious women, 
and amongst them never witnessed any 
trace of Hysteria; and this also I find is the 
experience of other doctors, even in silent 


ow 


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138 MINDS IN DISTRESS 


and purely contemplative orders who are 
not engaged in active outdoor work, and I 
am certain therefore that a well-directed, 
pure and high type of love amply suffices to 
meet all the instinctive requirements of the 
order to which I refer. Not only is Hysteria 
rare in nuns, but amongst no other class 
of women have I known such gaiety, con- 
tent and generally sound mental and 
physical equilibrium. 

Having then first of all secured a perfect — 
picture of the patient’s mind, of her real 
self, the doctor’s aim will be to sketch a 
path along which she can safely travel to- 
wards health, and as a first step thereto he 
will seek: 

(2) To alter her surroundings to her 
benefit. Friends, books, rooms, medicines, 
everything and everyone have been moulded | 
by the patient to serve as supports of, and 
a setting to, her state of invalidism, and all 
have become, in consequence, active agents _ 
of suggestion. This atmosphere must be 
changed. The patient’s muscles are weak 
from want of exercise, her digestion enfeebled 
by misuse, her mind restricted in range and 
concentrated on trivialities; in short, the 


3 


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TOO Me a 
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HYSTERIA 139 


difficulties seem to be almost unsurmount- 
able, and yet as both mind and body are in 
constitution sound, both will be found to 
have retained their elasticity and capability 
of a rebound to health and vigour if only 
the suggestive obstacles thereto can be 
removed. And here one of the sanest 
methods, that of Dr Weir Mitchell, comes 
to our aid. Its drawbacks are its quite 
unnecessary expense and the measure of 
discredit that has accrued to it from its 
application to unsuitable cases. Probably 
its novelty was for a time its greatest asset, 
for it has dropped considerably out of a 
favour which it did much to deserve. A 
grasp of the situation, common sense, a 
wise sympathy and gentle firmness, are the 
virtues of an efficient Weir-Mitchell nurse, 
for she is the great agent of cure. Visitors 
and letters and all exciting outside news are 
taboo for the first week or more, according 
to the patient’s conditions and needs. The 
doctor himself is often best out of sight, 
available at call if both nurse and patient 
agree in wishing to see him, but not unless, 
if everything is going well. I need not 
enter into details as to diet; this should be 


140 MINDS IN DISTRESS 


a very full one in the emaciated and re- 
stricted but varied in the corpulent. Simple 
or galvanic massage of the forehead and 
back of the neck late in the evening is a 
useful aid to repose. If that fail, the general 
hot pack or the local hot pack over the 
stomach should be resorted to. Real 
insomnia is not common, but in cases in 
which it is of occasional recurrence, and a 
source of trouble, I recommend a plan which 
I have found a specific for persons endowed 
with a vivid imagination. I simply in- 
struct the patient how to tell herself, silently, 
a story. This story is reserved only as an 
inducement to sleep; any theme that in- 
terests her may be selected, and she herself 
should be the central figure. In a week or 
less, a habit of picking up the story at the 
point at which it was dropped and continu- 
ing it, is developed, and the patient soon 
becomes thoroughly interested in the vari- 
ous fancied situations that arise. I know - 
many not hysterical sufferers who have 
used this simple plan for years, and who, 
once they have picked up the thread of 
their story, fall asleep in a very short time; 
it acts, moreover, by keeping all disturbing 


* 





HYSTERIA r41 


and unpleasant thoughts out of the mind. 
I find in men that military campaigns are 
selected as the favourite subject, and the 
same story in its various developments 


may extend over years. A much-worried 


business man wrote to say that he had 
followed my plan for fifteen years and that 
he felt sure that it alone had kept him out 
of the asylum, and though absolutely in- 
credulous at first even as to its possibility, 
he had found it easy and pleasant after 
a short perseverance. I adopted it for 
patients as a cure for sleeplessness thirty 
years ago, after remarking its utility in a 
highly-nervous family of children, and I 
have since found that story-telling aloud 
or to oneself is quite in familiar use as a 
sleep-producer in many nurseries. It is 
instructive to remark that, while the worst 
cases of Hysteria can and do avail themselves 
of the system, I have never known an insane 
person capable of doing so. 

The strict Weir-Mitchell system may be 
relaxed as the patient improves, but a 
mere increase in weight—often regarded as 
positive proof of a cure—must not in itself 
be taken as an advancement, for the cure of 


% 





















142 MINDS IN DISTRESS 


the mind is the great object in view and 
this must be directed towards some form’ of — 
activity suitable and possible to the patient’s | ¥ 
age and social status. Often one of the ’ 
colonies may be used as a lure, but the doctor — 
should never advise at random, but obtain, — 
if he does not possess it, a sure and certain — 
knowledge of the suitability of any place — 
recommended and necessary introductions, 
etc., for the patient. am 
Many cases of Hysteria occur among thea 
working classes, generally in men after an 4 
accident that has frightened them severely. $ 3 
They are not malingerers ; the paralysis— — Be 
for that is the form in which it is generally — 
seen—is real and beyond the control of the © 
will-power, though still only functional. It — 
is produced by the suggestion that several 
injury has resulted from the accident, and — 
is matured by the sympathies and sugges- __ 
tive allusions of neighbours. I have seen x 
many bad instances of it. Here also it is” 
essential to alter the surroundings of thea 
patient and to assure him of his ability ere 3 
long to return to work, an end which the ~ 
patient himself is often most desirous of oy 
attaining. 4 


HYSTERIA 143 


(3) Endeavour to find systematic embploy- 
ment for the mind. If you have carried out 
the first of my recommendations and really 
know the natural bent of her mind—and 
without this you will effect nothing at all— 
you are in a position to advise with effect. 
A child, even an adopted one if need be, 
for the childless is a sovereign remedy. 
For the woman who craves for marriage 
and the sympathy and love that attend it, 
a place in some colony which will give her 
a wider world to live in and a better oppor- 
tunity to marry than in England. For the 
woman tied to routine house duties and 
unmarried, some outdoor work is best, for 
home industries are bad. For the woman 
with a little money and some adaptability 
the stage is one of the very best of employ- 
ments. I shall never forget the case of a 
young lady of small income with inveterate 
Hysteria, who, on her parents’ death, took 
up that profession, and how quickly it made 
a cheerful, healthy and young woman out of 
a worn and sickly-looking invalid. I need 
not give a list of possible occupations, but. 
only say that they should be such as the 
patient feels specially drawn to and that 


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a 
4 


144 MINDS IN DISTRESS 


offer a decent remuneration for work done. 
Let not the silly bogy of nervous break- 
down obstruct anyone. In reality the 


hysterical woman is a little too full of ner- — 


vous energy which only wants direction into 
useful and desirable channels to produce 
excellent fruit; and the doctor may safely 
assure doubting relatives and friends that 
he will cheerfully take all risks if the patient 
will follow his advice strictly and will 
persevere. 

The above remarks apply to the still 
young and vigorous Hysteric, such as have 
not wilted through the years till they have 
become so irrevocably crooked, selfish and 
self-absorbed as to seem beyond the reach 


of any mental remedy; yet even of these © 


some recover. The most hopeless of all 


are the wealthy and elderly spinsters whose | 


susceptibilities none of their entourage dares 
to offend; but even for them the doctor who 
will not play the 7éle of a mere parasite can 
often do more than he at first thinks pos- 
sible; for behind all their mental and physi- 
cal obliquities more of discernment and 
judgment may remain than the casual on- 
looker would give credit for. I recall such 






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Da eee ee oe ee ee 


Su + 







Le ee ee 


HYSTERIA 145 


a chronic case of inveterate Hysteria, in 
_ which the patient announced the onset of 
a new disease by telegram at intervals of 
every few days, and who, in his (for the sex 
_ was male) intervals of relief from functional 


paralysis, would, to excite attention and 
sympathy, go into the garden and bah like 


a sheep, or plaintively mew like a kitten, or 


shower pebbles on the neighbours’ windows. 
He had summoned from London at various 
times every physician of name to minister 
to his symptoms, and always listened with 
apparent appreciation to their soothing 


platitudes, though he never took a dose of 


their physic nor followed one of their rules. 
To him, in my absence from town and by 
inadvertence, a very clever young surgeon 
was sent who, after a careful examination 
and a subsequent ink sketch of the organs 
with the handle of a pen on the patient’s 
abdomen, replied to the usual question, 
“ Now, what is your opinion of me?” with 


“You are the d——est fool I have seen for 


along time.” Instead of taking offence at 
this observation, the patient appreciated 
it, and long after used laughingly to say, 


“That is the most honest man I have ever 
10 


146 MINDS IN DISTRESS 


seen, though of course one could not live 
long on terms of the d——est fool with any- 
one.” I do not cite this example as any 
commendation of either the attitude of 
mind, or the special language, adopted by 
the surgeon, but to show that, in the worst 
cases, there is usually, though in quiescence, 
a certain sanity of observation which it 
should be the doctor’s aim to bring to the 
surface for use as his chief agent in the 
permanent cure of the invalid. In this 
case it was possible not only to do so, but 
to play also upon the patient’s love of 
wealth and of financial reputation, and thus 
gradually to wean him from the state of 
abject self-concentration into which he, a 
really capable man, had gradually sunk from 
taking the wrong road at the commence- 
ment of his disorder; in this case by retiring 
from active work in the City in order to 
make himself a literary reputation, a line 
recommended to him, because he had suf- 
fered from “ globus hystericus ” as a result 
of a sharp disappointment. 

I have always found it of the greatest 
advantage to address the hysterical sufferer, 
with whom I have established good terms, 





HYSTERIA 147 


from whom I have obtained a real life 
history, on the plane of his or her sound and 
actual self, and not on that of his or her 
hysterical and false personality. To ex- 
plain and emphasize this most important 
point let us take a supposititious case: 
“A” has been in bed for two years with a 
“phantom abdominal tumour,” areas of 
skin insensibility and bouts of hysterical 
vomiting, living in an atmosphere of pity 
and crowned with the halo of martyrdom. 
You have elicited the real history, and 
know the causes underlying it, and have 
agreed with the patient to “keep up 
appearances”’ with her friends for the 
present, but to work in conjunction with 
her for the satisfaction of what you know 
to be her special ambitions and desires; 
you have convinced her that you do 


not regard her as a malingerer and that 


you recognize clearly that her symptoms, 
though functional, are actual experiences to 
herself and beyond her power, by any simple 
act of good-will, to banish; that you have 
decided to place her in circumstances that 
will cease to hypnotize her and confirm her 
in the present disorder, and that when, by 


148 MINDS IN DISTRESS 


such measures and aided by her collabora- 
tion, she has obtained efficient self-control, 
you will do your best to arrange that her 
life shall in future be adapted to the natural 
calls of her mind, to her instincts, her am- 
bitions and her special capacities. Now, 
having established this most desirable 
mutual understanding, you must no longer 
treat her, when alone, as an _ hysterical 
invalid, but on the same level as you would 


sy 


a patient with a broken limb, an attack of — 


broncho-pneumonia, or other temporary ail- 
ment which is sure to get better, and dis- 
cuss the plans for her future advancement 
and success in life; not ignoring completely 
the tumour or vomiting, but referring to 
them as present inconveniences that are 
certain to pass away spontaneously as she 
becomes more normal. 

In short, as you are conspiring together 
to help her out of a mental prison, your 


conversation should naturally turn on the — 


pleasures of liberty. 

The foregoing recommendation, though 
not in any treatise in Hysteria that I know 
of, is not a trivial one, but I think recom- 
mends itself to sound judgment and com- 


| 
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HYSTERIA 149 


mon sense and is the outcome of a long 
__ practical experience. Its one aim is to 
extract all that is mentally good and 
; sound in the patient, and to build up 
- on that foundation a new and healthy 
mental life. 

(4) Dramatic mental appeals and sug- 
gestions. These sudden appeals to the 
imagination of the patient are rarely in 
the power of the doctor to command or to 
make use of. Faith cures, hypnotism, etc., 
are of this class, and the setting is as neces- 
Sary, even more so, than the actual pro- 
cedure. Thus,if you decide to avail your- 
self of any one of them, you must look to it 
that there is as large an audience as possible 
and that the réclame to follow shall be 
loud and far-reaching. Personally, I have 
always fought shy of them, while never 
opposing the patient’s inclination if it be 
firmly set on the trial, for the proportion of 
temporary successes is small, and that of 
permanent cures even less, since you cannot 
often keep up the effect when you have 
secured it. 

A typical “bed case”’ of several years’ 
duration went, in charge of a doctor, to 


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150 MINDS IN DISTRESS 


Nancy to undergo a course of hypnotism. 
The enthusiasm of her companion, and the 
novelty of the situation and of the treat- 
ment, brought about so much improvement 
that she spent a subsequent month alone 
at a bright seaside home, walking about 
and apparently well. She was, later on, 
brought back to her own house by the 
doctor, looking remarkably well and walking 
with confidence, for her Hysteria had taken 


the form of paralysis of both legs. After — 


the doctor’s departure she returned to her 
room and bed within an hour, and to my 
knowledge remained there for several years, 
in spite of every effort to again rouse her to 
activity. These brilliant cures effected by 
hypnotism rarely stand the wear and tear 
even of a sheltered normal life, for the want 
of any system of following them up, any 
subsequent systematic adaptation to their 
environment, and it must never be forgotten 


that no Hysteric who is not fitted by treat- 


ment to respond to the normal stimuli of 
life, z.e., to the ordinary conditions of life, 
can be regarded as cured. That is the only 
real test of recovery and nothing in the way 
of cure can be accepted in place of it. The 


HYSTERIA 151 


truth of this is before our eyes in the ana- 
logous condition of Alcoholism, which, like 
Hysteria, has in many cases a real and 
distinctive mental origin and dependence. 
The inebriates’ reformatories have proved 
a failure in the experience of those very 
practical judges, the London police magis- 
trates, and even a three years’ residence 
therein has resulted in failure, although, as 
I am assured by keen observers who have 
had charge of such institutions, the inmate 
had absolutely lost all temptation to take 
alcohol and all craving for its exciting effect 
for at least a year prior to her release; and 
could she only have been kept under some 
supervision when outside, provided with 
easy work and sheltered—as she was when 
in the institution—from the worries and 
anxieties of life, she would certainly have 
experienced no difficulty in a lifelong 
abstinence. One system of cure for 
Alcoholism must be referred to, for it has 
proved itself a success in America—and I 
do not give the name because I do not 
wish to advertise it—by wisely founding its 
plan upon a knowledge of human nature. 
First of all, it possesses an alluring name. 


1s2 MINDS IN DISTRESS 


Secondly, it impresses the patient further 
by allowing him when in the home to order 
and drink what alcohol he chooses, assuring 
him at the same time that the “ cure” is so 
certain that it will succeed, in spite of every- 
thing, in eradicating in four or five days the 
craving, or even the desire, for drink. On 
the first day nothing special is done, but on 
the second and subsequent days an emetic, 
nearly always tartar emetic or apomorphia, 
both of which are tasteless and very soluble, 
is placed in the alcohol, or given hypoder- 
mically, in such gradually-increasing dosage 
that the alcohol excites ever more nausea 
and repugnance till, if persisted in, such 
severe vomiting results that it has perforce 
to be declined. The proof of the pudding 
is in the eating, and the patient, knowing 
nothing of the actual cause of his vomiting, 
ascribes it to the super-excellence of the 
treatment and is duly impressed. But, and 


this is a masterpiece of foresight, when, after _ 


his six weeks or so of residence, the patient 
is sent home, he is put in touch with a 
local club, where he meets old patients, all 
talking about the wonders of the cure and 
burning with enthusiasm, a band of allies 


y 
Beh. 


‘ 
~ 


HYSTERIA 153 


and heroes whom it would be shameful to 
desert; in short, the stimuli of enthusiasm 
and success are behind the cured one, while 
the special disgrace of black treachery holds 
in front of him a restraining hand. By 
a similar wise plan the Salvation Army 
secures its potential backsliders from drop- 
ping back into the mire. 

With the Alcoholic as with the Hysteric, 
any sudden shock may cure even perma- 
nently. Many years ago I knew an Aberdeen 
bailie who, after years of addiction to the 
wine of his country, was so intensely shocked 
one morning, after copious libations to 
Bacchus, on finding that he had broken all 
his windows and lost a valuable watch and 
other things overnight, that he gave way 
to a copious flood of tears and never again— 
and he lived for many years—took alcohol 
in any shape or form. While two years 
later a lady who had been bedridden for 
years, and about whose actual state doctors 
had differed widely, some thinking that she 
had organic nerve disease, on losing her 
entire fortune in the failure of the Australian 
Banks, rose and went straight out to the 
Antipodes to a brother, whose active and 


7. inane ils ateaaillaaad Se 
_ . 


154 MINDS IN DISTRESS 


competent housekeeper she became hence- 
forward. 

But, in general, the rule holds good that 
in Hysteria, in order to really cure it, to make 
the sufferer normal in her response to the 
normal stimuli of everyday life, you must 
not lose sight of the patient till you have 
seen her comfortable, contented and happy 
in suitable surroundings. 

And since your first and only duty is to 


cure your patient, cito, tuto et jucunde, — 


according to the old formula, you must not 
despise faith-healing and similar measures. 
Nor must you be disturbed for one moment 
by thoughtless remarks about the absurdity 
and fraud of miracles, and the dishonesty 
of those who make use of them or venture 
to defend them in modern days. Such 
remarks show a confusion of thought, and 


you may be simultaneously on the side of | a 


science and that of the angels if you desire 


it, for science tells us that it is our minds 


that interpret, if indeed they do not make, © 


the external world. Let the blood but 


contain a novel ingredient so slight as to 


escape even the microscopist and the 
chemist, and, lo and behold! sight, sound. 





HYSTERIA 155 


touch, taste and smell may all so alter that 
a garden of Eden or a Gehenna may come 
into existence. A poison, you say. There 
are no poisons as such in nature, and the 
new ingredient need not even be deleterious ; 
it only need be different to the usual run of 
blood ingredients to produce a miracle in 
the partaker; and ifit were so widely diffused 
that all absorbed it, then the world would 
be changed for all of us, and with it even our 
present conceptions of time and space, nay, 
even the simplest facts of arithmetic might 
cease to hold good. We have abundant 
proof of this in the taker of Indian hemp, 
of opium, of cocaine and of other drugs, or 
even of alcohol in excess, and in the wide 
divergence of views in different nations and 
at different epochs in history. A China- 
man in New Zealand once told me that he 
had his heaven with him and exhibited a 
chunk of crude opium. You have only to 
imagine a race of men without the sense of 
sight to whom a man with vision would be 
one with miraculous faculties, since no one 
else could conceive of the possibility of sight. 
Is one single historical fact better sustained 
than the common existence of dragons 


156 MINDS IN DISTRESS 


formerly in Europe? Where are they? 
Our ancestors must have been great liars, 
a very uncharitable thought, or very credu- 
lous, scarcely possible considering that grants 
of land even in England were made for 
killing the monsters and much proof would 
be exacted ere such a reward were given. 
It is after all but an extension of the moral 
of the primrose by the river’s brim: to one 
it is nothing more, to another it represents 
a different world and train of thought. The 
lesson to be learnt is that there are many 
mental faculties possible, of which the 
ordinary man cannot conceive; though of 
course this should not lead us to accept 
the reality of wonders without the closest 
scrutiny of which we are capable. 

But I have digressed shamelessly and 
must pass on. 


(5) Medicinal, electro-therapeutic and me- 


chanical agents. I have never seen a 
case of Hysteria cured by any of the above 
agents, though urgent symptoms have been 
arrested. The rules I would lay down 
regarding them are as follows: In the 
beginning of a treatment, if you have 
assured yourself that it is within your 


Pas Sf ee ee ee ee 
* , , i 
i 





ep Ss ae eT 







HYSTERIA 157 


_ power to cure the patient by the mental 
means I have already enumerated, never 
use any of these agents unless it be with the 
_ well-understood reservation that they are 


recommended only as palliatives and do 
not enter into your scheme of cure. Other- 
wise, when they have failed you, as they 
are sure to do, you will be credited with 
having shot your best bolt, and any line 
of treatment you may subsequently adopt 
will be regarded as in the nature of an after- 
thought. 

In chronic cases in which, for some 
sufficient reason, you have decided that 


a radical cure is impossible, drugs and 


electricity alone are left to you, and then 
the best possible must be done with them. 
As in the case of Neurasthenia, tonics in 
Hysteria almost invariably do harm, if 
they have any action at all, by increasing 
the already over-stimulated and hyper- 
active nervous energy. Therefore those 
of the nature of strychnia, nux vomica, 
caffeine and phosphorus are absolutely 


taboo. If a blood examination shows the 


presence of anemia, a mild form of iron may 
be used, and it is best in that case to combine 


1s8 MINDS IN DISTRESS 


it with arsenic. The latter drug, indeed, 
alone of all the tonics, is ever of real value. 
It is not stimulating, and it has the effect, if 
given in very small doses and continuously 
for months, of improving the physical con- 
dition. Bromides are often of service, and 
if the patient has any objection to the 
salts of bromide in common use, I order 
bromide of gold in doses of 4 to rzth grain 
in pill form, or hydrobromic acid with syrup 
of lemons. Orange-flower water, greatly 
in repute in France, may also be given. No 
hypnotic should ever be ordered unless great 
care is taken that it cannot be repeated 
without the doctor’s sanction, for hysterical 
persons are absolutely reckless in their use 
of drugs, and often so careless about the 
amount ordered that danger is never far 


away if several doses of any hypnotic drug — 


are at their command. 

Most habitual morphino-maniacs and 
cocaine fiends have started as hysterical 
patients to whom, incautiously, morphia, 
opium or cocaine has been administered by 
a doctor or taken in some patent medicine. 

Chlorodyne is a great offender in this 
connection, as are some of the preparations 





ae ee ee 
7, pa a 7 " . 





HYSTERIA 159 


of heroin on the market, and coca wine. 
And the fact remains that opium and its 
derivatives, alone of all drugs, seem to have 
the actual power of curing Hysteria in many 
cases but at the expense of a far worse dis- 
ease, the opium habit. That drug stimu- 
lates the Ego in a direct way, and amongst 
its many other drawbacks, converts its 
victims into the most terrible of egoistic 
bores. Twenty years ago a lady, whose 
“ dollop,” as she styled it, varied from 100 
to 150 grains of extract of opium a day, 
was a source of real terror when she came 
to consult me. She would wait to see me 
till she was the last of all the patients, and 


_ then, calculating my lunch or dinner hour, 


beg for all the intermediate time. On the 
temptation of a conditional promise of 
matriage from a gentleman to whom she 
was attached, and who knew of her weak- 
ness, she made heroic efforts to conquer 
the drug, and eventually reduced it to a 
trivial dose, which she never exceeded. 
Her previous history is too instructive to 
omit. As a girl of eighteen she took to her 
bed, and at twenty-four had both ovaries 
removed as a means of cure, but obtained no 


160 MINDS IN DISTRESS 


relief whatever. One day a local doctor 
happened to call, and promising to cure her, 
ordered one grain of extract of opium every 
twelve hours. The first dose removed all her 
symptoms, a result by no means uncommon. 
The moral is, never give the drug in 
Hysteria. Cocaine is nearly equal in 
efficacy, but far and away more dangerous 
and terrible in its ultimate effects. The 
habit, common a few years ago, of taking 
coca wine often produced hysterical symp- 
toms when the wine was discontinued, 
and I have been more than once, in former 
days, puzzled by a sudden and severe attack 
of Hysteria developing without any discover- 
able cause in one who had been taking it. 
One gentleman, who had a bad attack with 
general tremor, told me that he had been 
in the habit for some weeks of taking as 


much as a whole bottle of the wine each > 


evening, feeling “‘ like a god” afterwards. 
He had no idea that he had been doing 
a very foolish thing; in fact the wine had 
been recommended to him as the best 


remedy for the weakness that follows on © 


influenza. 
Laxatives and purgatives should be 


[ , : 
te ae at 





HYSTERIA 161 


avoided in all diseases as they gravely 
_ derange the ordered muscular action of the 
- intestinal walls, and there is reason to think 
_ that their too frequent use is responsible 
for much of the appendicitis that is now 


seen. The covered 4lb. or 6lb. cannon ball, 
allowed to roll its way back and forwards . 
over the surface of the abdomen for about 
five minutes every morning before rising, 
is the best remedy for constipation. 

Unfortunately in Hysteria we cannot 
avail ourselves of the “ Infallible,”’ that 
medicine of such marvellous (mental) power 
in Neurasthenia; for one of the most striking 
features in which the two disorders differ is 
in the attitude of the patients towards 
drugs, which are loved by the Hysteric and 
dreaded by the Neurasthenic. 

Résumé. The cure of Hysteria depends 


in general on the personality of the doctor, 


on his knowledge, firmness, judicious sym- 
pathy, and above all on the confidence he 


_ inspires. Other mental forms of treatment 


are of occasional service, but drugs should 
be avoided, and electric treatment used only 
as a form of ‘“‘ passive exercise ’’ in chronic 


“bed cases,” to maintain the nutrition of 
It 


162 MINDS IN DISTRESS 


the muscles and nerves and the circulation 
of the blood. 


Disorders mistaken for Neurasthema and 
Hysteria 


Lying outside my definitions of Neuras- 
thenia and Hysteria there is a state of 
mental collapse that both in men and women 
may follow on want of sleep, on prolonged 
anxiety, and on any protracted struggle 
against adverse condition; and which is 
marked by insomnia, irritability, restless- 
ness, depression, inability to make up one’s 
mind in any important matter or to act with 
decision. 

That is Nervous Breakdown, and I dealt 
with it several years ago in a book called 
Depression, for that state is always one 


of its leading symptoms. Its underlying — 


cause is simple exhaustion of the nervous 
mechanism and a consequent temporary 
arrest of the mental faculties, a natural 
protest by the body against gross misuse 
and an urgent demand for rest, and sleep. 
It is to be met at once by absolute rest, and 
recovery is often aided by the administra- 
tion of a few doses of bromide of ammonium, 


»~ 





HYSTERIA 163 


which calms the mind and thus permits of 
natural sleep. After good sleep has been 
procured, and the patient is restored to fair 
comfort, it is well to advise him, after first 
putting his business affairs into order, to 
take a holiday at some resort where golf, or 
other suitable diversions, can be enjoyed. 
Unless there be some special indication to 
the contrary, he should not be pursued by 
doctors or by physic, lest his sensitive mind 
be turned to thoughs of self and Neurasthenia 
be brought on. If there be cause to suspect 
any tendency that way it is well to give 
him an “ Infallible’”? as a stand-by. He 
must be steered clear of nursing-homes, or 
of boarding-houses where the conversation 
chiefly turns on disease, for this variety of 
Nervous Breakdown is chiefly of importance 
because it is frequently, if not judiciously 
treated, the first step on the road to 
Neurasthenia. 

Hypochondriasis, which is often carelessly 
used as an alternative name for Neuras- 
thenia, should be restricted to its real place, 
that of a term to connote a well-known 
variety of Insanity in which delusions as 
to the bodily state exist. It presents a 


164 MINDS IN DISTRESS 


specious likeness to some kinds of Neuras- 
thenia, while really it is a variety of Melan- 
cholia, 7.¢., of Insanity. It is of great 
interest to students of Psychology, because 
the mental condition which it represents 
is dependent. on organic change in some one 
or more of the abdominal organs, and thus 
furnishes us with evidence of a statement 
which I have made elsewhere; that every 
cell in the human body probably contributes 
to mind, and may be potentially conscious 
under certain abnormal conditions, even 
such as under the usual conditions of life 
contribute to automatic mind, 7.e., to the 
reflex functions, chiefly or solely. One 
cannot, of course, in the present state of 
our knowledge be dogmatic on this point, 
though it has always seemed to me that 
researches into the causation of some forms 


of Epilepsy, and most varieties of Melan- — 


cholia, tend more and more to support my 
hypothesis. The present fashionable idea 
in medicine is that the connection between 
diseased bodily cells and the conscious 
brain is vid the blood, and the result of a 
toxemia; but if this were so it should be 
within the powers of science to demonstrate 


ee kh 


HYSTERIA 165 


the presence of toxic material in the blood 
in Epilepsy and in such of the Insanities 
as have no cerebral morbid anatomy. 

The hypochondriac, unlike the Neuras- 
thenic, rests in a delusion. It is a fact to 


him and he will not bandy words about it. 


He is not only insensible to, but intolerant 
of, any argument. “I’ve got to put up 
with it and I ought to know all about it,” 
is his pet phrase. His face and manner too 
are characteristic; for he looks ill, has a 
set expression and a furtive manner; he is 
suspicious of everyone, and you never get 
to really know him; whereas the Neuras- 
thenic is only too willing to unburden his 
very soul before you, and is anxious that not 
one single of his many symptoms shall be 
left out of the reckoning. 

But the essential difference between 
Hypochondriasis and Neurasthenia is that 
the former is a grave mental disease, rarely 
recovered from; the victim of which may be 
fitly compared to a ship in which the cargo 
has shifted and which has a permanent and 
dangerous list even in calm weather; whilst 
the latter is a mere group of symptoms 
which arise in a xorma/ individual when the 


166 MINDS IN DISTRESS 


surrounding conditions are abnormal; and 
the sufferer from it is like a well-found ship 
in a gale, the rolling and tossing of which are 
but oscillations round a centre of gravity, and 
essential to its safety under those conditions, 
and which will, when the storm has abated; 
again sail calmly over the sea, carrying 
little or but slight trace of the terrible com- 
motion through which it has passed. 

The Neuroses of the Alcoholic and of drug 
habitués may sometimes simulate Neuras- 
thenia, especially those that are seen when 
the victim is making an effort to overcome 
his weakness, but the history of the case, the 
absence of any “ bogy,” together with the 
extreme prostration and listlessness, soon 
undeceive an observer. This stage of dis- 
tress in recovery from great alcoholic excess 
and drug-taking is one not devoid of danger 
to life, and the mental depression that ac- 
companies it is not only extreme but liable 


to sudden exacerbations. I say this because. 


it is a popular delusion that Alcoholics and 
others, by some act of will, can at once re- 
form, and may expect a rapid improvement 
in their health by so doing. Such is not 
the case. If the person has become more 


. 
= 


a a 





HYSTERIA 167 


or less immune to the substance taken, he 
may enjoy good and even excellent health 
whilst indulging himself, and must be warned 
not to be daunted by the months of ill-health 
that will succeed to his most commendable 
resolve to free himself of the tyranny. 

The above are the disorders that are 
occasionally brought to me, even by doctors, 
as cases of Neurasthenia, and the absurd 
nomenclature of use in medicine is alone 
responsible for the confusion. By reason 
of such misunderstanding, I have found 
myself compelled to refer to them, though 
they are quite outside the scope of this book 
and are not breaches of the principles laid 
down in my Preface and earlier chapters, 


CHAPTER IX 
MENTAL FORMULA: 


IND as a term is undefinable and as 

a process unthinkable. We simply 
have to accept it, to assume it, and to make 
the best effort possible to classify its various 
powers, always keeping in mind that, though 
its control centres have their freds-a-terre 
in the brain, yet each cell of the body adds 
its quota to the product, and, like the private 
soldier, makes the army of which the direc- 
tion is in the hands of comparatively few 
specially-trained men. Its division, made 
solely for convenience, into conscious, sub- 
conscious and unconscious, is even artificial, 
since there is a free communication between 
them all. How then can we assign values; 
and how are the values to be expressed ; and 
how are we to allow for the essential fluidity 
of mind and for the consequent perpetual 
shifting of our values? The problem is 


insoluble. 
168 


=.) >a ee 
ae SD tay 
Vat «Sr, 

. ee ¥ 


MENTAL FORMULA 169 


Yet it would be useful and instructive 
to have some plan, however elementary, to 
enable us to visualize the way in which, as 
far as we can judge, the mind works when it 
is “made up,” when its balance has been 
effected; and therefore I venture to make 
the attempt. 

The environment supplies the energy 
with which we have to do mental work, and 
this energy is utilized in two ways; it is either 
inlubited and stored as memory or reserve 
energy of some kind; or exhibited and used 
in the production of thought and new com- 
binations of ideas, or in action of some kind. 

What decides the relative proportion of 
this division? The Will, but if you ask 
me further to give the origin of this faculty 
of Will I can only answer, that it must be 
viewed either as a direct emanation from 
a higher mind (the Heilige Geist), or as the 
outcome of the varying forces, exerted by 
the general opinion of the day (the Zeitgeist 
or Weltgeist), upon the mind of each one 
of us; the pressure and direction of public 
opinion, as the newspapers would phrase it. 
That the individual Will can also, under 
certain conditions and to a limited extent, 


170 MINDS IN DISTRESS 


_be directly and potently affected by another 
mind we see in hypnotism, in spiritualism, 
and in the result of a stern word of command 
on wavering troops in battle; but we also 
seem ourselves to possess in some undefin- 
able way a power of control and direction 
over it. 

We will assume that the three usual 
divisions of the mind are valid ones, for both 
observation and experiment incline us to 
the acceptance of this as a general truth; 
and selecting quite arbitrarily the number 
roo as the sum of mental energy in the 
mind, we will try and assign such a due pro- 
portion of it to each division as we should 
expect to find in a normal masculine and a 
normal feminine mind; and then we shall 
be able to understand why the conditions 
underlying Neurasthenia and Hysteria 
inevitably lead to the increase of activi- 
ties in certain directions and to their 
necessary decrease in others; in short, we 
shall thus see why the Neurasthenic must 
veason and why the Hysteric must show 
explosive activities in one direction and a 
more or less complete loss of activity in 
others. 





* ane. 
t= 


oo.) Sem 


MENTAL FORMULA 


NorRMAL AVERAGE MASCULINE TYPE oF MIND 


Determined by effect of wt// and habit 


Environment Total Amount 


Conscious Portion 


A. Ideas relating to self. 30 
_B. Ideas relating to others 15 
C. Sensations (impressions) 15 


Subconscious Portion 
D. Instincts : : ‘ 10 
EK. Impulses and intuitions 10 

Unconscious Portion 


G. Reflex muscular and secre- 
-tory impulsions ; 20 


LOO 


171 


Distribution 


Inhibited Exhibited 


15 


Io 


5 


oo 


8 


54 


55 
5 


Io 


12 


46 


The above is taken as representative of 
the ordinary average distribution of energy 
as determined by the effect of will and by 
habit. Habit is not a separate faculty, 
but merely a line of least resistance, the 
outcome of frequent use in one direction. 


In NEURASTHENIA 


Environment Total Amount 


Conscious Portion 

A(+) . 40 
—“B(-) . ae j 

C (- in general impres- 

sions ; + in suchas 

relate to self); 15 


Distribution 


Inhibited Exhibited 


172 MINDS IN DISTRESS 


Environment Total Amount Distribution 
Inhibited Exhibited 


Subconscious Portion 


Bats ; . ; : 10 8 2 
S's ; ; : 10 8 2 

Unconscious Portion 
os : : ‘ ; 20 8 12 
100 42 58 


The normal proportions are seen to be 
upset, and 42% of the activities of the 
conscious mind is exhibited as reasoning 
activity in place of the normal 307%, while 
only 15% instead of 30% is stored as 
memory or diverted into other channels. 
It is necessary, moreover, to remember 
that the will power is presumably weakened 
by the increase of pressure on it at A, and, 
since the mind is exceedingly fluid, or, to 
use a better term, elastic, unduly increased 
in resistance elsewhere. In short, endless 
disturbance of mental energy is apparently 
possible, but in the masculine mind the 
conscious division is so predominant in 
power that the greatest variation from the 
normal will be seen there, and this masks 
the other and minor disturbances which are 
always present in Neurasthenia if looked 
for. The great excess in activity of the 





MENTAL FORMULA 173 


reasoning power is so outstanding a feature 
in Neurasthenia that the casual observer 
fails to remark such phenomena as dilatation 
and sluggishness of the pupils, increased 
activity of the reflexes, distaste for muscular 
exertion, partial loss of control over memory 
(not loss of memory), etc. etc., which one or all, 
with many others, accompany the disorder. 

We now pass to the picture of the feminine 
mind, viewed first as it is in the normal 
state, and then as we should expect to see 
it when in functional disarray. 


NORMAL AVERAGE FEMININE TYPE OF MIND 
Determined by effect of w#// and hadit 
Environment Total Amount Distribution 


: ; Inhibited Exhibited 
Conscious Portion 


A. Ideas relating to self . 20 10 IO 
B. Ideas relating to others 5 2 3 
C. Sensations (impressions) _—_10 5 5 
Subconscious Portion 
D. Instincts’. ee 3° aa : a] 5 
E. Impulses and intuitions 15 10) 828.5 5 
Unconscious Portion g a 
G. Reflex muscular and secre- 
tory impulsions . ; 20 8 12 
100 55 45 


3 There is here noticeable a tension in the 


174 MINDS IN DISTRESS 


subconscious portion, a division in which 
the repressive effects of the Zeitgeist, which 
is largely the product of the masculine mind 
as expressed in society, and above all in the 
press and literature of the day, is evident 
as a check. The relative proportions of 
the inhibited and exhibited amounts is 
thus kept back under ordinary conditions of 
life so as nearly to be identical with that 
seen in the masculine type of mind. 

The reader will also note in the above 


formula that a larger proportion of the total 


output of mental energy is assigned to the 
instincts and impulses of the subconscious 
mind, and a smaller amount to the conscious 
mind, than in the masculine mind type. I 
think that he will agree with me that such 
a proportionate allowance is in accordance 
with general experience. 


In HYSTERIA 


Environment Total Amount Distribution 
: ; Inhibited Exhibited 
Consctous Portion 


yk . : . 27 5 22 
). 3 3 ° 
in aie as relate to 
others; + in such as 
relate to self) . ; 5 I 4 





7 
{ 
: 


oe eee ee eee ee ae 


MENTAL FORMULA 175 


Environment Total Amount Distribution 
, Inhibited Exhibited 


Subconscious Portion 


DD. . : ; ‘ 30 10 20 

E 15 I 14 
Unconscious Portion 

G. ; f ‘ : 20 8 12 

100 28 72 


The barrier made by subservience to 
predominant masculine popular opinion has 
gone, broken down as one of the conse- 
quences of the disorganization of the for- 
mula of health which has arisen largely from 
an over-development of the self idea, re- 
presented by A, and the consequent dis- 
turbances of proportionate output. 

Again I must ask the reader to remember 
that these formulz have no pretence what- 
ever to any exactitude and are introduced 
only to show graphically, 1st, The general 
effect of environment; 2nd, The difference 
in mental constitution between the masculine 
and feminine minds; 3rd, The disturbance 
that must ensue chiefly as the result of 
isolation, of an over-development of self, 
as a factor in the environment; 4th, The 
place of will in determining the proportion 


176 MINDS IN DISTRESS 


in which the mental output of each portion 
shall be allotted, what part of it shall be 
stored and what part be expended in mental 
or physical activities. The part arrested 
and stored representing the fund of reserve 
energy always present in the brain and 
mind. What no formula can represent is 
the ever-varying power and direction of the 
will, and the influence of this, and of the 
environment, in increasing activities in 
certain directions and paralysing them in 
others. 

What it is desired to teach is that, by 
studying the environment throughout life, 
and by training the will, especially in early 
life, we may avoid, unless possibly much 
predisposed thereto, the mental and physi- 
cal troubles that follow on a neglect of 
those all-important indications. 

To forestall, I hope, all criticism I beg 
the reader to regard the above objects as a 
valid excuse for presenting him with such 
elementary formule. With the assistance 
of a friend I some time ago endeavoured 
to construct more pretentious ones on a 
wider basis and with the values represented 
mathematically in considerable detail, but 


MENTAL FORMULA 177 


the result, though interesting, was even 
still devoid of any scientific accuracy, while 
it became so perplexing as to render 
it unintelligible to any but the mathe- 
matical mind and would have been quite 
out of place in such a book as the present 
one. 


I2 





INDEX 


ALCOHOL, craving, 151, 166 
— cure of habit, 151 
Ambitions, 65 

Anzemia, 157 

Analysis of secretions, etc., 60 
Animals and a common mind, 92 
Arsenic, 158 

Atomism, I 


BALANCE, mental, 7, 15, 28, 37 

Bashi-Bazouks, 105 

Bastian, Dr Charlton, 6 

Bogies, see Phobias and Obses- 
sions 

— can be foretold, 53 

— how generated, 53 

— treatment of, 62, 75 

— varieties of, 53 ef seg. 

Brain, divisions of, 114, I19, 
123 

— pied-a-terre of mind, 82 

Bromides, 49, 158 

Burton, Robert, 65 


CANNON-BALL, I61 
Carlyle, 64 
Catalepsy, 118 

Celt, 25, 102, 104 
Charcot, 66 

Charity, 100 

China tea, 67 
Chlorodyne, 158 
Christian Science, 134 
Church of England, 104 
Climacteric, 112 

Coca wine, 160 
Cocaine, 160 
Common sense, 7, 95 


179 


Conventions, 133, 173 
Courage in hysteria, 131 


DEFINITIONS, faulty, 86 
Delusions, 52, 163, 165 
Depression, 162 

Disease, organic, 47 
Disseminated sclerosis, 80 
Distress, mental, 8, 13, 114 
Double personality, 117 
Dramatic appeals, 149 
Drugs, 69 

— abuse of, 158 

— habitués, 166 


EGO, 5, 31, 91, 97, 132 
Electro-therapy, 156, 161 
Emergency medicine, 62 
Emotions, 126 

Energy in Hysteria, 144 

— in Neurasthenia, 43 
Environment, 10, 169, I71, 173 
Epilepsy, 118, 164 
Examination of patient, 60 


FACTS, 17 

Faddists, 45 

Faith-healing, 154 

Fasting, 118 

Feminine mind type, 24 ef seq., 
81 ef seq. 

— best type, 83, 96 

— effects of, in history, 25 

— failures of balance in, 84, 99 

— mental formula of, 173 

— three main varieties of, 108 

Fibroid tumours, 112 

Food fads, 68 


180 


Food fads in Neurasthenia, 67 

Functional disease, a re-equili- 
bration, 37 

— and health, 114 

Functions of mind, 5 


GALEN, 64 

General paralysis, 80 
Gift of tongues, 122 
Grammar of science, 2 


HABIT, 171, 173 

Health topics, to be avoided, 71 

Heart-beat reduced, 31 

Heart-to-heart talk, 129 

Heilige Geist, 169 

Hermit mind, 41 

Home Rule, 103 

Hypnotism, 66, 149 

Hypochondriasis, 19, 163 

— not Neurasthenia, 165 

Hysteria, 26, 31, 56, 81, 108 
él seq. 

— causes of, 31 

— contrasted with Insanity, 115 

— disequilibration, 28, 81, 95 

— disorder of entire brain, 87 

— major, 109 

— suicide in, 33 

— symptoms of, 114 

— treatment of, 36, 128 e7 seg. 

Hysterical cases, 32, 116, 123, 
134, 144, 150 


IMPOSTURE in Hysteria, 115, 
125, 136 

— in Spiritualism, 90 

Indian hemp, 118 

Infallible medicines, 62, 163 

Insanity, 12, 115, 164 

— result of toxzemia, 12 

Insomnia, cure of, 146 

Instincts, 29, 98, 133 

— perverted 120 

— starved, 108 

Intuition, 24 

Isolation, effects of, 23, 40, 
94 


MINDS IN DISTRESS 


JAMES, William, 1 
Jaundice in hysteria, 123 


KNOWLEDGE, contrasted with 
understanding, 4 


LiFE, backwaters of, 42 
Logic, 18, 22 
Lombroso, 93 


MALINGERING, 124, 142 

Mapped areas of brain, 6 

Marriage, 136 

Masculine mind, 17 é¢ seg. 

— inferiority of, 96 

— predominance of, 18, 100 

Melancholia, 52, 164 . 

Mental balance, 7, 13, 27 

— comfort, 8, 9, 15 

— composition, 9 

— equation, 119, 168 

— exercises, 70 

Mind, balance of, I e¢ seg. 

— conscious, 5, 171, 173 

— divisions of, 114, 119, 123 

— great divisions of, 17; 24 

— insane, 12 

— isolation of, 40 

— one and indivisible, 2, 168, 
171 

— organic (reflex), 5, 171, 173 

— the generator, 3 

— throws out a balance, 8, 10 

Misunderstood persons, 132 

Monism, I 

Morphia, 76, 158 


NEGATIVISM, 44 
Nervous breakdown, 162 
Nervous debility, 43 


Neurasthenia, absence of organic 


disease in, 47 
— a disequilibration, 81 
— a functional disorder, 37 
— class of mind affected in, 23 
— disorders mistaken for, 162 


— energy in, 43 
— foods in, 67 








> a a Pp 


= 


INDEX 


Neurasthenia, examples of, 49, 
50, 63, 73, 79 

— sexual, 72 

— suicide in, 51 

— symptoms of, 37 ef seg. 

— treatment of, 44, 59 ef seq., 


77 
Numbers three and seven, 56 
Nuns, hysteria rare in, 138 


OBSESSIONS, see Bogies 

— how generated, I1, 53 
Opinions, written, 61 
Opium, Chinese taker of, 155 
— in hysteria, 159 
Overwork, 39 


PARALLEL, running of a, 45 

Pearson, Dr Karl, 2 

Phobias, II, 53 

Phosphorus, 49, 157 

2 ipa parent of anatomy, 
2 


Practical views, IOI 
Protopiasm, synthetic, 3 
Psychasthenia, 43 

Psychic immorality, 116, 137 
Puberty, 112 

Purgatives, 160 


QUACKS, 73 
Quinine, 49, 76 


RacEs of different mind-type, 18, 
25 

Reason, 101 

Reflex functions disturbed, 84, 
121, 173 

Responsibility in hysteria, 115 


181 


Rest cures, bad, 65, 78, 79 
— good in nervous breakdown, 
162 


Scots, Lowland, 18 
Sensuality, 74 

Sexual congress, 136 
— neurasthenia, 72 
— physiology, 113 
Shock as cure, 153 
Spiritualism, 89 
Strain and stress, 42 
Strychnine, 49, 76, 157 
Suffragist movement, 103 
Suicide, 33, 51, 52 
Sympathetic ganglia, 7 
Syphiliphobia, 45 


THEORIES as counterbalances, 
8, 27, 35, 53 

Tobacco, 69 

Tonics, 157 

Toxzemia, 164 

Traumatic hysteria, 142 


VEGETARIANISM, 68 
Virility, loss of, 73 

Vis Medicatrix Nature, 38 
Vomiting, fecal, 124 


WEIR-MITCHELL system, 139 

Will, 169 

Women, kind fitted for work, 
III 

Work, 39, 50, 63, 142 

Worry, 39 


ZEITGEIST, 134, 169 
— defined, 35 





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